A 48-year-old female patient is brought to the emergency room by her husband. He reports that his wife suffers from hypertension but, as a high-level executive with a lot of pressure at work, she has been neglecting to take her medication. This morning, as he entered the garage to leave for work, he found his wife lying on the ground next to her own car. She was experiencing uncontrolled flailing of the left arm and leg. What is the most likely site of brain lesion in this patient?
- anterior limb of the left internal capsule
- anterior limb of the right internal capsule
- cerebellum
- left subthalamic nucleus of Luys
- right subthalamic nucleus of Luys
Answer(s): E
Explanation:
Hemiballismus is a movement disorder characterized by involuntary large amplitude movements of one or both limbs on one side of the body. It results from infarct damage to the contralateral subthalamic nucleus of Luys, in this case the right one. The left subthalamic nucleus (choice D) controls the limbs on the right side of the body, which are not affected in this case. The anterior limbs of the internal capsule (choices Aand B) contain mainly thalamocortical and corticothalamic fibers and lesions in these areas do not result in hemiballismus. Lesions in the cerebellum (choice C) also do not result in hemiballismus.
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