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A 65-Year-Old Man Comes to the Emergency Department Due to Acute-Onset

question 144

Multiple Choice

A 65-year-old man comes to the emergency department due to acute-onset slurred speech. He also has right-sided weakness but denies any trauma, headache, or loss of consciousness. His medical problems include hypertension and type 2 diabetes mellitus. The patient has smoked 1 pack of cigarettes daily for 20 years. Neurologic examination shows right-sided lower facial droop with sparing of the forehead muscles. Motor strength is 3/5 on the right and 5/5 on the left with a Babinski response on the right. There is also dysmetria and dysdiadochokinesia involving his right upper and lower extremities. MRI of the brain reveals an acute lacunar infarct in the brainstem, as shown in the image below. Which of the following cranial nerves exits the brainstem closest to the level affected by this patient's stroke?

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Definitions:

Non-Bonding Electrons

Electrons in an atom that are not involved in bonding but occupy the outer electron shells or orbitals.

Formal Charge

The charge assigned to an atom in a molecule, assuming that electrons in all chemical bonds are shared equally between atoms.

Oxygens

are chemical elements with the symbol O and atomic number 8, essential for respiration and combustion processes, often found in molecular forms.

Formal Charge

A theoretical charge assigned to an atom in a molecule, calculated based on the assumption of equally shared electrons in bonds.