A 65-year-old man arrives at the emergency department with acute slurred speech. He is likewise weak on the right side, although he denies any damage, headache, or loss of consciousness. His medical issues include hypertension and type 2 diabetes. For the past 20 years, the patient has smoked one pack of cigarettes every day. A neurologic examination reveals right-sided lower facial droop, with the forehead muscles spared. Motor strength on the right is 3/5 and on the left is 5/5, with a Babinski response on the right. His right upper and lower limbs are similarly affected by dysmetria and dysdiadochokinesia. As illustrated in the figure below, an MRI of the brain indicates an acute lacunar infarct in the brainstem. Which of the following cranial nerves exits the brainstem closest to the level affected by this patient's stroke?

Question

A 65-year-old man arrives at the emergency department with acute slurred speech. He is likewise weak on the right side, although he denies any damage, headache, or loss of consciousness. His medical issues include hypertension and type 2 diabetes. For the past 20 years, the patient has smoked one pack of cigarettes every day. A neurologic examination reveals right-sided lower facial droop, with the forehead muscles spared. Motor strength on the right is 3/5 and on the left is 5/5, with a Babinski response on the right. His right upper and lower limbs are similarly affected by dysmetria and dysdiadochokinesia. As illustrated in the figure below, an MRI of the brain indicates an acute lacunar infarct in the brainstem.  Which of the following cranial nerves exits the brainstem closest to the level affected by this patient's stroke?

Quizplus · Accepted Answer

Eductional Objective: Due to disruption of the ipsilateral corticospinal and corticobulbar circuits, infarcts affecting the anterior region of the medial pons can cause dysarthria and contralateral hemiparesis/lower facial palsy. The trigeminal nerve emerges from the lateral portion of the mid-pons at the level of the middle cerebellar peduncle.

A 65-Year-Old Man Arrives at the Emergency Department with Acute