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School of Medicine >
Department of Neurology >
Medical Student Cases and Questions >
The man with the evolving stroke
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This 69 year old black male was admitted with a chief complaint of vertigo and ataxia. Three
days before admission he bean to feel vertiginous and his gait became slightly ataxic. His vertigo
worsened and, on the day before admission, he began to complain of diplopia and left ear tinnitus.
When he became dysarthric and his ataxia worsened on the following day, he came to the StonyBrook
ER. On examination, he had a right medical rectus paresis. There was gaze-directed nystagmus in a
lateral direction and rotary nystagmus when he looked up. There was decreased appreciation of
light touch and pin-prick sensation on the left V1-V3 distributions and a paresis of both the
upper and lower portions of his right face. The right palate did not elevate, and the uvula
deviated to the left. He had severe dysarthria. He was ataxic with a wide-based gait and dysmetria
on left finger-to-nose testing. He had a past medical history of hypertension, diabetes, and
previous strokes.
Questions:
- What is the anatomic localization of the lesion causing this man's symptoms and signs?
- What is the name of this cerebrovascular syndrome?
- Describe the pathophysiology of this lesion.
- What is the treatment for this syndrome?
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