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?

• A)Facial
• B)Hypoglossal
• C)Oculomotor
• D)Trigeminal
• E)Trochlear

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Definitions:

Withdrawn

A state or behavior characterized by a reluctance to engage with others or participate in social activities, often due to emotional or psychological reasons.

Securely Attached

A term describing individuals who have a positive view of themselves and their relationships, leading to healthy and trusting interpersonal connections.

Separation Anxiety

A disorder characterized by excessive fear or anxiety about being apart from attachment figures or familiar home environments.

Unpredictable Temperament

An individual's behavioral style that is irregular or difficult to forecast, affecting how they react in various situations.