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Neurology


Answer 1
  1. Acute left ACA stroke. Although the patient’s complaints are focused on leg weakness, the physical examination also reveals weakness in the right arm. The involvement of both the arm and leg would not be explained by a process in the lumbar spine, and lateralized involvement to the right would not be explained by a cervical disk herniation. ACA strokes affect motor and sensory function in the leg much more profoundly as compared with the rest of the body. On the homunculus (the topographical representation of motor function in the cerebral cortex), the portion associated with the lower extremity is located in the medial aspect of the cerebral hemispheres in the region supplied by the ACA. In contrast, left middle cerebral artery strokes produce more uniform hemiparesis, affecting both the motor cortex as well as deep brain structures, and impairment of language and visual fields is also seen in conjunction with hemiparesis and sensory loss.

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