A 55-year-old male presents complaining of "difficulty writing" using his dominant hand and some "slurred" speech. He has a history of hypertension, DM type II, and hypertriglyceridemia. Which of the following would you anticipate to find on a CT scan of his head, as the explanation for his chief complaint?
- hemorrhage in the distribution of his posterior cerebral artery
- hemorrhage in the distribution of the middle cerebral artery
- hypodensity measuring 12 mm by 21 mm in the distribution of the posterior cerebral artery
- hypodensity measuring 4 mm by 4 mm in the internal capsule
- calcifications bilaterally, in the third ventricles
Answer D
Hypodensity measuring 4 mm by 4 mm in the internal capsule
The main clue to this question is that most strokes are ischemic - especially with this patient's history (ruling out hemorrhagic infarct - A & B). Calcifications (E) are not indicative of stroke at all. When trying to decide between C & D - the size of the area needs to correlate with the patient's symptoms. If the patient had a HUGE infarct (12 x 21) he would have significantly more signs and symptoms than just some slurred speech and difficulty writing. (In addition, as it turns out, the internal capsule is supplied by the MCA - which is the most common vessel involved in an ischemic stroke)
Know Your Content Blueprint
CVA and stroke are covered as part of the NCCPA Content Blueprint Neurologic System (6%)
