A 68-year-old woman with a 20-year history of hypertension is brought to the emergency department 30 minutes after the sudden onset of right-sided weakness. Her speech is dysarthric. Physical examination shows drooping of the right side of the face. Visual field testing shows no deficits. Muscle strength is 4/5 in the right upper extremity and 3/5 in the right lower extremity. Deep tendon reflexes are 2+ in the upper extremities and left lower extremity and 3+ in the right lower extremity. Sensation is intact throughout. Babinski sign is present on the right. Mental status examination shows no abnormalities. Which of the following is the most likely cause of this patient's condition? A) Border zone hypoperfusion B) Embolism of the right anterior cerebral artery C) Lacunar infarct of the internal capsule D) Ruptured aneurysm of the circle of Willis E) Thrombus of the left posterior cerebral artery
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The presence of a Babinski sign on the right also indicates a central nervous system lesion. Given her history of hypertension, a small vessel (lacunar) stroke is most likely. Lacunar strokes occur due to occlusion of the small, penetrating arteries that provide Show more…
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