A 65-Year-Old, Right-Handed Man Comes to the Emergency Department Due

A 65-year-old, right-handed man comes to the emergency department due to sudden-onset, right-sided weakness.  The patient was watching television an hour ago, when his family noted that his face appeared "twisted."  He also experienced weakness of his right arm and leg but no headache, nausea, vomiting, or loss of consciousness.  The patient has a history of hypertension and is nonadherent with medications.  He is a former smoker with a 20-pack-year history.  Temperature is 36.7 C (98.1 F) , blood pressure is 164/72 mm Hg, pulse is 65/min, and respirations are 14/min.  Physical examination shows weakness of the right lower face and right upper and lower extremities.  Pupillary reflexes, ocular movements, and visual field testing are normal bilaterally.  Speech is without aphasia, and the patient correctly names his left and right arms.  Sensory examination is normal throughout.  Noncontrast CT scan of the head reveals no intracranial bleeding.  Which of the following is the most likely site of a lesion in this patient?

A) Left frontoparietal cortex
B) Left internal capsule
C) Left lateral pons
D) Right frontoparietal cortex
E) Right internal capsule
F) Right lateral pons

Correct Answer:

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