Chapter 10, Problem 2CRPA

Summary Introduction

Introduction:  The nervous system controls and coordinates all the activities of the animals. It is classified into two major types, namely central nervous system (CNS) and peripheral nervous system (PNS). The central nervous system includes the brain and spinal cord. The PNS includes cranial nerves and their branches, spinal nerve and their branches, peripheral branches, and plexuses.

Case summary: The patient was admitted on January 14 for progressive right hemiparesis suffering from last 1 to 2 months. He was having fluctuating numbness of the right arm, thorax, and buttocks. He was also having jerking of the right leg; diminished comprehension in reading; period of speech arrest; and recent development of a hemiplegic gait. He was suspected of having a left parietal tumor. He was examined for skull films (cerebral angiography), EEG, and CSF analysis before hospitalization and all reports were normal.

After admission, the patient was examined for MRI. MRI report was abnormal in left parietal region.

He was attempted for MRA to assess the cerebral blood vessels but he becomes more restless and agitated. Therefore the procedure was stopped. Actually he developed almost a complete aphasia and right hemiplegia.

Within a couple of days, he became more alert. But remained dysarthric and hemiplegic.

On January 19, the MRI and MRA study under general anesthesia showed the complete blockage of the left internal carotid artery with cross-filling of the left anterior and middle cerebral arteries from the right internal carotid circulation. The final diagnosis was left cerebrovascular accident (CVA) caused by left internal carotid artery occlusion.