1. SALIENT FEATURES

2. History of more than a year use of OCP
Left-sided weakness
History of more than a year use of OCP
No known co-morbids
HISTORY

3. PHYSICAL EXAMINATION Intact sensorium GCS 15 Conversant but dysarthric
Cranial Nerve V and VI deficits
0/5 Motor strength on the left
50% pain and temperature deficit on the left
(+) Babinski
Normal DTRs

4. Is there a lesion?
What is the lesion?
Where is the lesion?

5. Is there a lesion?
What is the lesion?
Where is the lesion?

6. IS THERE A LESION?
What is the lesion?
Where is the lesion?

7. Is there a lesion?
What is the lesion?
WHERE IS THE LESION?

8. LOWER MOTOR NEURON LESION
Where is the lesion?
UPPER MOTOR NEURON
LESION
LOWER MOTOR NEURON LESION
PARALYSIS OR WEAKNESS
Flaccid Paralysis
NO MUSCLE ATROPHY
Atrophy
Spasticity
No spasticity
Clasp knife reaction
No clasp knife reaction
Hyperreflexia
Loss of reflexes
(+) BABINSKI SIGN
(-) Babinski sign

9. Where is the lesion? CORTICAL SUBCORTICAL
Higher cortical functions are affected
HIGHER CORTICAL FUNCTION SHOULD BE NORMAL
Normal cranial nerves
Visual field cut
Face/Arm > Leg weakness and sensory deficit
(or vice versa)
FACE = ARM = LEG WEAKNESS AND SENSORY DEFICIT
(OR VICE VERSA)
Hyperreflexia, and Babinski’s reflex (if the corticospinal tracts are hit)
Reflexes may be abnormal

10. Where is the lesion?

11. Where is the lesion?

12. Where is the lesion?
Spinothalamic Tract

13. Is there a lesion?
What is the lesion?
Where is the lesion?

14. Differential Diagnosis
Factors suggestive of the disease
Factors that are not suggestive of the disease
Cerebrovascular disease, infarct or hemorrhagic in origin
Acute in onset
Hemiparesis with associated slurring of speech
Brain Abscess
Focal neurologic deficits hemiparesis (frontal lobe) and dysphasia (temporal lobe)
Headache (75%)
No previous history of infection, head trauma or neurosurgical procedure
No fever (50%)
Intracranial tumor, primary or metastatic
Acute focal neurologic symptoms ( secondary to bleeding)
Headache
No seizure or other signs of increased ICP
No systemic symptoms such as malaise, weight loss, anorexia or fever

15. INITIAL PRIMARY WORKING DIAGNOSIS
Cerebrovascular disease, Infarct vs. Bleed, Internal Capsule and thalamic area, RMCA territory