Case 72

 A forty four-year-old male presented in our hospital suffering from sudden weakness of left upper and lower extremities. He had no healthy troubles until two days before. Early in the last morning, he felt difficulty of walking toward washroom because of weakness of upper and lower extremities. Although it was difficult to walk straight, he took his daughter to kindergarten by his own car. When he carried his daughter and drove a car, he felt weakness of left extremities. However, he felt improvement of left extremities around 10 am. Thereafter, he worked all day without feeling weakness. In the previous a couple of months, he had stressful works, inducing the increase number of cigarettes. When he wakened up this morning, he felt weakness of left extremities again. He came to our hospital for further examination. Blood pressure 180/ 112 mm Hg Laboratory test revealed white blood cells of 11030 /mm³, Uric acid 7.3 (4-7) mg/dL, neutral fat 535 (30-150) mg/dL, total cholesterol 270 (120-220) mg/dL, LDL cholesterol 159 (<140) blood glucose 119 mg/dL.

 Brain MRI was conducted after his consent (Figs1-4).

What is the acceptable combination between the components of internal capsule and neurological pathway ?

a. Anterior limb -------- pathway to thalamus & cerebellum

b. Genu ----------------- motor pathway to eye & mouth

c. Posterior limb ------- motor pathway to upper & lower extremity

d. Retrolenticular part - visual pathway to posterior lobe

e. Sublenticular part --- auditory pathway to temporal lobe

　1.a, b, c　　 2. b, c, d　　 3. c, d, e 　　 4. all

answer

2017.9.20