Friday, May 8, 2009


A 65 year old man suddenly collapsed. He was unarousable except for painful stimuli and did not move his right limb at all. He had hypertension but poor compliance to medication. His mother passed away because of complication of hypertension.

On examination, he is obese. Blood pressure is 260/140 mmHg. There is no neck stiffness. There was no speech and did not respond to verbal stimuli. His right limb did not move even with painful stimuli. There were present of hyperreflexia and hypertonia of extensor right upper and lower limb. There were present of plantar response. There was no papilloedema.

1. Interprete the neurological findings in this patient (2marks)

2. State the most likely diagnosis and site of lesion in this patient. (2marks)

3. List 4 risk factor for the presenting features in this patient (4marks)

4. Briefly describe the pathogenesis of the presenting features in this patient (3marks)

5. Relate his clinical condition and his speech abnormality (2marks)



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