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Don’t neglect the clock drawing test
  1. Michal Vinker Shuster1,
  2. Maayan Hannah2,
  3. Zalut Todd2
  1. 1 Hadassah Ein Kerem Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
  2. 2 Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
  1. Correspondence to Mrs Michal Vinker Shuster, Hebrew University of Jerusalem, Shikun Hariel 3/4, Jerusalem, Israel;{at}


Introduction A 63-year-old, right-handed woman with a history of hypertension presented to the ED with left arm paresis of 2 days duration. Three weeks before admission, she had flu-like symptoms with intermittent left arm weakness that had recovered briefly but recurred 2 days prior to her presentation. On neurological examination, GCS was 15 and cranial nerves’ function was normal. Left upper limb strength was 4/5. There was left arm drift and pronation but the patient denied noticing any difference between the positions of her arms. Hyper-reflexion was presented in the left arm. The rest of her motor, cerebellar, sensation and gait functions were normal. She was asked to draw a clock and set it to 15:30 (figure 1).

Figure 1

Clock drawing test results.

Question: What is the most probable aetiology?

  1. Right cerebral bleeding involving the occipital lobe

  2. Right middle cerebral artery occlusion

  3. Right parietal lesion, likely neoplasm

  4. Left cortical stroke


  • Neurology
  • Emergency Departments

Statistics from


  • Contributors The case of this image challenge was written by the authors, and the diagnosis was also made by them.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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