Part 2: Ischemic Stroke: Evaluation, Treatment, and Prevention
Matthew Brandon Maas, MD, and Joseph E. Safdieh, MD
Dr. Maas is a fellow in Stroke and Neurocritical Care, Harvard Medical School, Departments of Neurology, Massachusetts General and Brigham and Womens Hospitals, Boston, MA. Dr. Safdieh is an assistant professor of neurology, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY.
Questions 4–8 refer to the following case.
A 72-year-old man is brought to the hospital after being found on the floor by his wife at 5 pm. His wife reports that he had been normal before taking a nap in his recliner chair. When she found him, he was unable to stand up due to weakness in his right arm and leg, so she called 911. He arrived at the hospital 30 minutes after his wife initially discovered him on the ground. The patient has a history of hypertension, dyslipidemia, and atrial fibrillation. His medications are warfarin, lisinopril, metoprolol, and atorvastatin. He has not had a stroke or transient ischemic attack (TIA) in the past. A rapid initial survey shows that his vital signs are stable. He is breathing comfortably and his airway sounds clear. A general physical examination shows no evidence of significant trauma. The rhythm monitor and electrocardiogram (ECG) show atrial fibrillation with a rate near 70 bpm. The ECG also shows ST-segment depression in the precordial leads. A standardized National Institutes of Health Stroke Scale (NIHSS) examination is performed. The patients deficits are as follows: partial right visual field hemianopsia; paralysis of the lower face sparing the brow; no movement in the right arm or leg; severe sensory loss over the right face, arm and leg; and mild dysarthria. The total NIHSS score is 14. The patient is right handed.
This patients clinical syndrome is most consistent with an occlusion of which artery?