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CVA Case Studies
Welcome to the CVA case studies. 

At the hospital, the doctors perform an MRI. They explain that an MRI is considered the "golden standard" for the initial evaluation of patients after a stroke because of its excellent soft tissue contrast and that they use the MRI to rule out a hemorrhage (Birenbaum et al). 

They determine that you had a stroke in the right superficial division of your middle cerebral artery. "The middle cerebral artery is the most common site of strokes ('Stroke Model')," your doctor explains.

"What?" you say. 

"The middle cerebral artery supplies blood to the lateral surface of your cerebral hemispheres, your language areas, your basal ganglia, and your sensorimotor and premotor areas (Barone)," your doctor says. "Your stroke took place in the right superficial division of this artery, which means it affects blood flow to your motor cortex. That is why you can't move your left head, neck, trunk, and arm. You may also feel numbness or lack of sensation in your left head, neck, trunk, and arm ('Stroke Model')." 

Over the next couple days, your nurse comments that she thinks you also have left hemineglect due to damage to non-dominant association areas ("Stroke Model"). 

"What's that?" you say. 

"Some people call it 'unilateral neglect' or 'spatial neglect.' It's actually pretty common. After brain damage, some patients fail to be aware of items to one side of space. It's most prominent and long-lasting after damage to the right hemisphere of the brain, which is where your stroke was. It means that you are not aware of objects on your left side (Husain)." she explains.

"Really? I didn't know I had a problem with that," you say.

"That's actually pretty common. Many patients are unaware that they have a deficit (Husain). But I noticed that you only eat food from the right side of the plate. You also wear your shirt with only your right arm in the shirt sleeve," she points out. "And if you look in the mirror, you can see that you've only shaved one side of your face!"



"I don't think so," you say.

"How about this. Can you copy a picture of the clock on the wall?" she asks.

"Of course," you say. You draw a perfect picture of the clock on the wall and show it to her.



"In this picture, you only wrote in the numbers on the right side of the clock," she says. "I think you have anasognosia."

"What's that?" you ask. You are confused by all these big terms that the nurse is throwing at you.

"That means that you don't know that something is wrong with your vision, or you are denying that there is a problem (Sutton, 2014). You may have to consider getting visual attention therapy for your left neglect." 

Luckily for you, you experience spontaneous recovery of your left hemineglect about three weeks after your stroke. This is consistent with studies which report spontaneous recovery of neglect being most common in the first weeks after stroke, or up to 14 weeks after the stroke (Kessel, 2013). However, you continue to experience weakness on the left side of your body following the stroke.