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Amelia Frankish is 67 years old. She

Amelia Frankish is 67 years old. She presented to her GP last week, complaining of a very strong headache, followed by dizziness. The symptoms had resolved by the time she could see the GP, who was concerned enough to request a CT (computerised tomography) of Amelia’s head and neck. Loss of consciousness or syncope: NO Seizure activity: NO Asymmetric facial weakness: YES Asymmetric arm weakness: YES (rightâupper limb paralysisâ-âunable to respond to movement request) Asymmetric leg weakness: YES (rightâlower limbâparesis – mild weakness) Speech disturbance: YES (some slurring of words (dysarthria) is noted) Visual field deficit: NO Other: Limb sensation:ârightâupper limbâanaesthesia;ârightâlower limbâ- paraesthesia (tingling feeling).â Amelia appears pale and anxious. She has not had her medications today. â Investigation data – performed AFTER triage Cardiovascular assessment An ElectroCardioGram (ECG) is undertaken which showsânormal sinus rhythm.ââââ Blood tests are ordered including full blood count (FBC), urea & electrolytes (U&Es), liver function tests (LFTs), coagulationâstudies (COAGs) including Anti-Xa levels. Metabolic assessment Blood Glucose Level (BGL): peripheral 9.8 mmol/L (Amelia reports not having eaten since yesterday, nor has she had her medications today)â Computerised Tomography report Exam Information Modality: CT Body Part: NEURO Description: CT Brain Performed Date: 25/3/Year Time: 0830 Final Report CT BRAIN CLINICAL NOTES: Patient presents with severe headache, dysarthria, limb anaesthesia, paresis, and paralysis. CT 7 days ago – no adverse findings Findings: A non- contrast CT has been acquired. Nil intracranial haemorrhage noted. Complete occlusion of the left middle cerebral artery noted. IMPRESSION: Middle cerebral artery thrombosis (not conclusive). ; Consider today’s CT brain finding. Explain the relationship between this finding and the limb paralysis and paresis Amelia is experiencing. Describe the anatomical structures, and the physiological and pathophysiological mechanisms involved.

 
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