08-31-2008, 07:20 PM
44. A 67-year-old man is brought to the emergency department 2 hours after the onset of weakness and double vision. He has hypertension and hyperlipidemia treated with metoprolol, captopril, and atorvastatin. His blood pressure is 190/106 mm Hg. Neurologic examination shows left-sided facial weakness including the forehead.
There is palsy of left conjugate gaze, and the left eye fails to adduct on right gaze.
Vertical eye movements are intact. Muscle strength is 3/5 in the right upper and lower extremities. Deep tendon reflexes are brisk, and Babinski's sign is present on the right. Which of the following is the most likely location of this patient's lesion?
A) Bilateral thalamic
B) Left frontal
C) Left pontine
D) Right caudate
E) Right midbrain
There is palsy of left conjugate gaze, and the left eye fails to adduct on right gaze.
Vertical eye movements are intact. Muscle strength is 3/5 in the right upper and lower extremities. Deep tendon reflexes are brisk, and Babinski's sign is present on the right. Which of the following is the most likely location of this patient's lesion?
A) Bilateral thalamic
B) Left frontal
C) Left pontine
D) Right caudate
E) Right midbrain