Tired Swimmer

Clinical Case Study

Nervous System

History of Present Illness: Gene Matson, a 75 year old male, was brought to the hospital

by his son following the acute onset of left-sided numbness and weakness that began one

hour prior to admission. His son stated that two weeks prior to admission Gene had a

single, 12-hour episode of garbled speech and left-sided face and arm weakness. Following

the first episode the right carotid angiogram pictured below was performed.

Past Medical History:

History of moderate hypertension treated with calcium channel blockers. History of 

hypercholesterolemia. Mr. Matson smoked one pack of cigarettes per day for forty years, and drank 

approximately four beers per day for several years. 

Physical exam: Temperature: 37°C. Pulse: 72. Respirations: 12. BP 170/100  

Neurological exam: Showed left‐sided hemiplegia (paralysis on one side) and hemianesthesia 

(numbness on one side).  

QUESTIONS  

Answer the questions below to demonstrate your knowledge. 

1. What are the pertinent aspects of the patient's past

medical history that are risk factors for his current

medical problem? 

2. Damage to which lobe(s) accounts for the patient's

sensory and motor deficits?  

3. Give an anatomical explanation for why damage to the

right side of the brain may cause sensory and motor

problems on the contralateral (opposite) side of the body. 

4. Is there a surgical procedure that might have prevented

the current episode? If so, what is the procedure called? 

5. Relate the findings in the angiogram to the patient's past

and present neurological problems in terms of:

a. how the vascular lesion could lead to neurological

problems.

b. what specific blood vessel in the brain must have been

affected by the process in "a" to account for his

symptoms.  

6. What abnormality does the angiogram show? Describe the

lesion and the vessels in which it is located?