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Question 1

Which of the following signs and symptoms would commonly be seen after occlusion of the MCA stem in the left hemisphere (assume that the left hemisphere is dominant for language in this patient).
Indicate ALL correct answers. 

a. Inability to understand or carry out spoken or written commands
b. Inability to speak more than a few stereotyped words
c. Lack of response to threatening gestures (visual threat) when they are given on only the left side
d. Paralysis of the right arm
e. Paralysis of the right leg
f. Paralysis of the left leg

Answer to Question 1

Correct Answer: 

a. Inability to understand or carry out spoken or written commands

b. Inability to speak more than a few stereotyped words

d. Paralysis of the right arm

e. Paralysis of the right leg

Additional Information:

Remember that the MCA stem was occluded on the left. This patient would fail to respond to visual threat on the right not the left, since the visual radiations represent the contralateral visual fields of the two eyes. Left MCA occlusion would not affect the left leg, but could affect the right arm and leg because of damage to the primary motor cortex and deep white matter including the internal capsule on the left. While the primary motor cortex devoted to the leg is in ACA territory, the leg fibers (part of the corticospinal tract) run in the deep white matter and internal capsule, both of which are in MCA territory and would have been damaged in such a large MCA stroke.