A patient with an embolic stroke is demonstrating urinary incontinence, contralateral weakness, and altered mental status. This location of the embolism is most likely the:
1. Middle cerebral artery
2. Anterior cerebral artery
3. Posterior cerebral artery
4. Vertebrobasilar artery
2
Rationale 1: Middle cerebral artery occlusions commonly produce hemiparesis, hypesthesia on the opposite side of the body, hemianopsia, and gaze preference toward the side of the lesion.
Rationale 2: Anterior cerebral artery occlusions primarily affect frontal lobe function and can result in disinhibition, speech perseveration, altered mental status, impaired judgment, contralateral weakness, and urinary incontinence.
Rationale 3: Posterior cerebral artery occlusions affect vision and thought, producing homonymous hemianopsia, cortical blindness, visual agnosia, altered mental status, and impaired memory.
Rationale 4: Vertebrobasilar artery occlusion is difficult to detect because it results in a wide variety of cranial nerve, cerebellar, and brainstem deficits.
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