A 68-year-old male with a history of poorly controlled hypertension suddenly starts flailing his left upper extremity

A 68-year-old male with a history of poorly controlled hypertension suddenly starts flailing his left upper extremity. Of the following, what is the most likely diagnosis?

A. Acute cerebral infarct involving the right red nucleus

B. Acute cerebral infarct involving the right subthalamic nucleus

C. Acute infarct involving the right cerebellar hemisphere

D. Acute cerebral infarct involving the right cingulate gyrus

E. Acute cerebral infarct involving the right internal Capsule

The sudden onset of flailing (involuntary, uncontrolled movements) of the left upper extremity in a patient with a history of poorly controlled hypertension suggests a neurological event. Let’s analyze the given options:

A. Acute cerebral infarct involving the right red nucleus: The red nucleus is located in the midbrain and is involved in motor coordination. An infarct in this area could cause motor deficits, but flailing movements of the left upper extremity are not typically associated with a red nucleus infarct.

B. Acute cerebral infarct involving the right subthalamic nucleus: The subthalamic nucleus is involved in regulating motor function, and damage to this area can lead to movement disorders. However, flailing movements are not a typical presentation of subthalamic nucleus infarcts.

C. Acute infarct involving the right cerebellar hemisphere: The cerebellum plays a critical role in coordinating voluntary movements. An infarct in the cerebellum can result in motor disturbances, including ataxia (lack of coordination) and abnormal movements. Cerebellar infarcts could potentially cause flailing movements, especially if the infarct affects specific cerebellar pathways.

D. Acute cerebral infarct involving the right cingulate gyrus: The cingulate gyrus is primarily involved in emotion and cognitive functions. An infarct in this area is less likely to cause the sudden flailing of the left upper extremity.

E. Acute cerebral infarct involving the right internal capsule: The internal capsule contains important motor and sensory pathways that connect the cerebral cortex to the brainstem and spinal cord. Damage to the internal capsule can result in motor deficits, including hemiparesis (weakness) or, in severe cases, flailing movements of the contralateral (opposite side) extremities.

Given the presentation of flailing movements involving the left upper extremity, the most likely diagnosis among the options provided is:

E. Acute cerebral infarct involving the right internal capsule.

However, it’s important to note that this is a clinical scenario, and a definitive diagnosis would require a thorough neurological evaluation, imaging studies (such as a brain MRI or CT scan), and additional clinical information to confirm the location and nature of the infarct. Immediate medical attention is crucial for proper evaluation and management of the patient’s condition.