CVA during replacing a flat tire on the road

[Oak]

A 56 year old male mechanic suffers a stroke while trying to replace a flat tire on the road. He has a history of hypertension, but had not been taking his medications regularly. In addition, he is a heavy smoker, and drinks a six-pack of beer every weekend. On examination, he is conscious and has difficulty speaking clearly. A right upper motor neuron paralysis of the facial nerve is noted; the other cranial nerves are normal. He has a dense hemiplegia on the right side, with equal paralysis of the arm and leg. His lesion most likely involves the

A. convexity of the left frontal lobe
B. convexity of the right frontal lobe
C. corticospinal tract in the upper cervical spinal cord
D. left internal capsule
E. right internal capsule

[bharat]

I think this patient has got Hypertensive intracerebral hemorrhage ,regarding his history of hypertension,age,alcohol,cig. smoking...and is concious but has difficulty in speaking and...hemiplagia...so in such cases of intracerebral bleeding associated with hypertension most commonly occurs in the tissues of the basal ganglia, pons, cerebellum, and deep white matter of the brain
so i suppose option c is promising but iam not sure so waiting for your reply

[Oak]

bharat its D. This patient has sustained a hemorrhage of the left internal capsule secondary to uncontrolled hypertension. The internal capsule receives its blood supply from the lenticulostriate arteries, which are prone to rupture in uncontrolled hypertension. The anterior limb of the internal capsule conveys frontopontine fibers, the genu conducts corticobulbar fibers, and the posterior limb of the internal capsule conveys corticospinal fibers to the contralateral arm and leg. Hemorrhage of the left internal capsule results in right-sided dense hemiplegia in which paralysis of the arm and leg are of the same intensity.

The convexity of the frontal lobe (choices A and B) does not control the leg. This is done by the medial aspect of the cerebral hemisphere.

Also, a hemorrhage involving the right frontal lobe (choice B) would affect the left side of the body. This patient has right-sided paralysis.

Lesions of the corticospinal tract in the upper cervical spinal cord (choice C) would result in hemi- or quadriparesis/plegia. The cranial nerves would not be involved.

Hemorrhage involving the right internal capsule (choice E) would result in left-sided paralysis.