CVA with right hemiparesis and deviation of angle of mouth to left ... possible site of infarct will be?
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Merck Manual localization unilateral facial weakness contralateral hemiparesis cerebral infarct
Left cerebral hemisphere infarct, most commonly involving the left middle cerebral artery territory affecting the motor cortex or corticospinal/corticobulbar fibers in the corona radiata or posterior limb of the internal capsule.
Reason:
- Right hemiparesis localizes to a lesion above the pyramidal decussation on the left.
- Deviation of the mouth to the left implies weakness of the right lower facial muscles, so the intact left side pulls the mouth leftward.
- This is an upper motor neuron facial palsy accompanying contralateral limb weakness.
If there is dense, equal weakness of face, arm, and leg without cortical signs, the classic localization is a left posterior limb internal capsule lacunar infarct. If cortical signs such as aphasia or gaze deviation are present, suspect a left MCA cortical infarct.
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