Answer and Discussion of Quiz Set: N-025

2.    A 45 year-old man with history of poorly controlled hypertension was admitted to the emergency by his friends. According to his friends, the patient has just collapsed in a banquet. On neurologic examination, the patient has unclear mental status but he was able to follow simple commands. There was significant weakness of his left upper and lower extremities. What is the most likely finding on CT scan? 

A.  Hemorrhage in his right side  basal ganglia with extension to the internal capsule

B.  Hemorrhage in his right side  basal ganglia with extension to the internal capsule

C.  Hemorrhage in his hypothalamus with extension to the anterior commissure

D.  Subdural hematoma in the frontal tip

E.  Hemorrhage in the cerebellum

Answer and Discussion: The answer is (A). The left side weakness on both the face and the left side extremities indicates that the right motor cortex or its downs stream axons are affected. The efferent signal of the the motor cortex pass through the internal capsule. Hemorrhage in the basal ganglia is one of the most common location for hemorrhage in the brain in patients with hypertension.