The Daily PANCE and PANRE Question 18

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?

  1. hemorrhage in the distribution of his posterior cerebral artery
  2. hemorrhage in the distribution of the middle cerebral artery
  3. hypodensity measuring 12 mm by 21 mm in the distribution of the posterior cerebral artery
  4. hypodensity measuring 4 mm by 4 mm in the internal capsule
  5. 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%)


A 69-year-old with facial droop and weakness (watch video)
Learn more about CVA and stroke, take the lesson quiz and view this ReelDx video case at SMARTY PANCE stroke

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