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Image challenge
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; michal.vi{at}gmail.com

Abstract

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
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

Question:

  • Neurology
  • Emergency Departments

https://doi.org/10.1136/emermed-2017-206680

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    Footnotes

    • 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.