LESIONS

A Guide to Localisation in Neurology

Case 1. Right-sided weakness and inability to speak

Case

An 80 year old woman was brought to hospital by ambulance unable to speak or move her right side.

30 minutes earlier she had been mid-phone call to a neighbour when her speech became abnormal. The neighbour came to the house immediately and found her on the couch, alert but unable to speak, making only noises, and with obvious right-sided paralysis and a right facial droop. The friend called an ambulance.

The patient was normally independent and healthy, with little past medical history other than high cholesterol and well-controlled diabetes.

On examination, she had:

• Inability to say anything other than incomprehensible noises
• Inability to follow simple 1-step commands
• Right facial droop and right sided weakness with no power in the arm or leg
• A left gaze preference
• No blink reaction to right-sided threat stimulus, but normal to left-sided stimuli

More in-depth testing was not possible, but her left-sided strength appeared intact. She appeared alert, but unable to communicate, rather than being drowsy and obtunded. Blood pressure was 160/88mmHg.