CASE 1

– A 50 year old male patient with sudden onset of inability to speak and a weakness of the right arm and leg.
– Patient is awake but unable to utter a single word
– Neurological findings:

Patient is unable to answer question

He is as if “ Attempting to speak” but unable to find words to respond.

He can, however, follow simple motor command (e.g. close his eye, show his teeth)
– Cranial nerve examination revealed a right central nerve palsy.
– Motor testing using the MRC grading:

2/5 muscle strength on his arm and leg

5/5 muscle strength on his left limbs

– Sensory testing cannot be reliably be done because the patient cannot respond coherently.
– Positive Babinski sign on the right
– Plain cranial CT scan was done
– He was started on medication for his stroke syndis.
Review the blood vessels of the brain. Which blood vessels is
most likely affected?
Major Blood Vessels of Brain

• Anterior Cerebral Artery

• Middle Cerebral Artery
• Posterior Cerebral Artery
How would you explain the patient language problem?
Discuss the anatomical basis of the patient speech
problem?
– Aphasia is an inability to comprehend or formulate language because of
damage to specific brain regions. This damage is typically caused by a cerebral
vascular accident (stroke), or head trauma; however, these are not the only
possible causes.
– Broca’s aphasia results from damage to a part of the brain called Broca’s area,
which is located in the frontal lobe. It’s one of the parts of the brain responsible
for speech and for motor movement
– Anything that causes the death of brain cells may result in aphasia. Brain cells
die when blood flow or oxygen flow to a particular part of the brain is stopped
or diminished.
– Causes include:
– stroke
– brain tumor
– injury to the brain, such as from a severe blow to the head or gunshot wound
– infection in the brain
– progressive neurological conditions, such as Alzheimer’s disease
How is muscle strength being graded?
Explain the MRC grading system.
Muscle Strength Grading