296.A 63-year-old woman was brought into the emergency room by her
son, who suspected she had suffered a stroke the previous night. Subse-
quent examination revealed spastic hemiplegia on the left side with hyper-
reflexia and a positive Babinski’s sign. The left side of the patient’s face was
paralyzed below the eye, and the right eye was turned out and down. The
right pupil made direct and consensual responses to light, but the left pupil
was fixed and unresponsive. There were no apparent sensory deficits.
Which is the most likely location of the lesion?
a. Left motor cortex
b. Right sensory cortex
c. Right midbrain
d. Left thalamus
e. Right thalamus
297.A 75-year-old man was rushed to the hospital from his retirement
community when he suddenly became confused and could not speak but
could grunt and moan. The patient could follow simple commands and did
recognize his wife and children although he could notname them or speak
to them. Additional immediate examination revealed weakness of the right
upper extremity. Several days later, a more comprehensive examination
revealed weakness and paralysis of the right hand and arm with increased
biceps and triceps reflexes. Paralysis and weakness were also present on the
lower right side of the face. Pain, temperature, and touch modalities were
mildly decreased over the right arm, hand, and face, and proprioception
was reduced in the right hand. The patient had regained the ability to artic-
ulate a few simple words with great difficulty, but could notrepeat even
simple two or three word phrases. Which artery or major branch of a large
artery suffered the occlusion that produced the observed symptoms?
a. Anterior choroidal artery
b. Middle cerebral artery
c. Posterior communicating artery
d. Ophthalmic artery
e. Anterior cerebral artery
418 Anatomy, Histology, and Cell Biology