| Course | PA 528 Comprehensive Clinical Module Neurology |
|---|---|
| Week | 2 |
| Paper type | Lesion localization exercise |
| Length | About 740 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 528 Week 2
Lesion Localization Exercise: Nine Deficits in B.T. Mapped Row by Row to the Right Frontoparietal Cortex and Its Underlying White Matter, With the Brainstem Ruled Out and the Question of a Second Lesion Answered
Student Name
Chamberlain University
PA 528: Comprehensive Clinical Module Neurology
Instructor Name
Month Day, Year
Lesion Localization Exercise: Nine Deficits in B.T. Mapped Row by Row to the Right Frontoparietal Cortex and Its Underlying White Matter, With the Brainstem Ruled Out and the Question of a Second Lesion Answered
The Site
One lesion, in the right frontoparietal cortex and the white matter immediately beneath it, in the territory of the right middle cerebral artery.
Every Deficit Gets a Row
Table 1
Deficits Mapped to the Structures That Carry Them
| Deficit, with side | Structure that carries the function | Level implied |
|---|---|---|
| Left lower facial weakness, forehead spared | Corticobulbar fibers from the right motor cortex | Above the facial nucleus |
| Left arm drift and weakness, grade 3 of 5 | Right precentral gyrus, lateral surface | Right cortex or its descending fibers |
| Left leg weakness, grade 4 of 5 | Right precentral gyrus, near the midline, or deep fibers | Hemisphere; mild |
| Left hemisensory loss to pinprick and position | Right postcentral gyrus and thalamocortical fibers | Right parietal cortex or below |
| Extinction of left-sided touch on double stimulation | Right inferior parietal cortex | Cortex |
| Rightward gaze preference, overcome by head turning | Right frontal eye field | Cortex, above the gaze centers |
| Dysarthria without language error | Corticobulbar fibers, bilateral output | Supranuclear |
| Tongue deviates to the left | Corticobulbar fibers to the left hypoglossal nucleus | Supranuclear |
| Left plantar response upgoing | Corticospinal tract, right | Anywhere above the lumbar cord |
Note. Note. Strength graded on the 0 to 5 Medical Research Council scale. Findings from the emergency department examination at two hours.
Why the Rows Converge
Every deficit is on the left and every implied structure is on the right, above the brainstem. Three rows, extinction, gaze preference and cortical sensory loss, point specifically to the cortex. The face and arm rows point to the lateral convexity, where the face and hand areas lie. No row requires a structure outside the right hemisphere.
Why Not One Level Lower
A lesion in the brainstem would usually add a deficit on the right side of the face or eyes, a crossed pattern, and would not cause neglect or a gaze preference that the patient can be coaxed out of. The gaze preference here is overcome by turning the head, which shows the brainstem gaze centers work; the problem is the cortical command above them. A lesion in the cervical cord would spare the face and tongue entirely.
Why Not a Deep Lesion Alone
A small deep lesion in the internal capsule can cause equal weakness of face, arm and leg without any cortical signs. B.T. has cortical signs and a leg that is less weak than the arm, which argues for a lesion that reaches the cortex. A deep component cannot be excluded, and the mild leg weakness may reflect it.
One Lesion or Two
Could two lesions explain this better? A single lesion in one arterial territory explains every row. Two lesions would be needed only if a deficit appeared that the right hemisphere could not produce, such as right-sided weakness or a crossed cranial nerve sign. None is present, so the simpler answer stands.
The Study at the End
Noncontrast CT of the head, with CT angiography of the head and neck, to exclude bleeding and to look for a blocked artery that might be treated with clot retrieval, as the acute stroke guideline recommends for patients who may be candidates (Powers et al., 2019). The localization predicts what the images should show: early changes or a blocked vessel in the right middle cerebral artery territory. If the images showed a lesion elsewhere, the localization would need to be revisited, not the images explained away. The scale score of 9 is recorded alongside, using the scale's original items (Brott et al., 1989).
What the Images Showed
The CT showed no bleeding and subtle loss of the gray-white boundary over the right frontal operculum. The angiogram showed an abrupt cutoff in the upper of the two main branches of the right middle cerebral artery, just past the trunk. Both fit the localization. B.T. was outside the window for clot-dissolving medicine because the time last seen well was uncertain, and the branch occlusion was judged too distal for clot retrieval at the receiving center.
References
Brott, T., Adams, H. P., Jr., Olinger, C. P., Marler, J. R., Barsan, W. G., Biller, J., Spilker, J., Holleran, R., Eberle, R., & Hertzberg, V. (1989). Measurements of acute cerebral infarction: A clinical examination scale. Stroke, 20(7), 864-870. https://doi.org/10.1161/01.STR.20.7.864
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344-e418. https://doi.org/10.1161/STR.0000000000000211
The Chamberlain PA 528 Week 2 instructions
The second week is a localization exercise of a page or two. State the answer, a single site, in the first line. Fill a grid with one row for every deficit, not only the convenient ones, giving the structure that carries each function and the level each implies. Below the grid, argue: explain why the rows converge, why the lesion is not one level lower or higher, and why a deep lesion alone would not explain the findings if cortical signs are present. Address whether one lesion or two fits better, and prefer the simpler answer unless a deficit demands otherwise. End by naming the study that would confirm the site and say what you expect it to show. Cite the guideline for imaging and any scale you use.
Inside the PA 528 Week 2 example
The site is given in one line: the right frontoparietal cortex and underlying white matter in the right middle cerebral artery territory. Table 1 lists nine deficits, from lower facial weakness sparing the forehead to an upgoing left toe, each with its structure and implied level. A convergence section notes that every deficit is left-sided and every structure right-sided, with three rows pointing to cortex. The brainstem and cervical cord are argued out using crossed signs and a gaze preference overcome by head turning. A deep capsular lesion is weighed against the cortical signs. Two lesions are shown to be unnecessary. CT and CT angiography are requested citing the acute stroke guideline, and the images show subtle frontal changes and a cutoff in the upper branch, with the treatment window explained.
Reading the PA 528 Week 2 grading rubric
Faculty grade this exercise heavily on the grid. A grid that fills only the rows that support the answer, or that leaves out the structure or level for some deficits, loses the most. The site must be stated first; an answer that emerges only at the end costs points. Credit goes to argument beneath the grid explaining convergence and excluding the next level. The deep-versus-cortical question earns marks when it is settled with specific signs. Considering one versus two lesions is expected, and choosing two without a deficit that requires it is a deduction. The study at the end is graded on whether it would confirm the site and on stating what it should show. Scales and imaging guidance should be cited.
Common PA 528 Week 2 mistakes, and how to avoid them
The grid usually goes wrong when students fill only the rows that fit their answer. Share your case deficits and any grid your section supplies, and the exercise prepared for you would state the site first, give every deficit a row with its structure and level, and then argue beneath the grid. The next level down is excluded with specific findings, and a deep lesion alone is weighed against any cortical signs. The one-or-two-lesion question is answered openly. The study that would confirm the site is named, with what it should show. If your case localizes to the spinal cord or brainstem instead, the same approach applies with different rows. Confirm each structure against your neuroanatomy text before relying on the grid.
Get a PA-528 Week 2 example written to your instructions
Send the exercise sheet, the template or grid if your classroom supplies one, and the deficits exactly as they are worded. A custom example is written to that case and returned inside 24-48h, the first one free. If the assignment arrives as an image of a form, send the image; the example is built on the same rows your grader will read.
More PA 528 papers and MPAS samples
- PA 528 Week 1: Lesion Localization Post
- PA 528 Week 3: Cranial Nerve Deficit Map
- PA 528 Week 4: Motor Neuron Brief
- PA 528 Week 5: Seizure Semiology Write-up
- PA 528 Week 6: Episodic Symptom Timeline
- PA 528 Week 7: Stroke Syndrome Correlation
- PA 528 Week 8: Neuroimaging Request Brief
- PA 526 Week 2: Abdominal Quadrant Brief
- PA 524 Week 2: eGFR Estimate Write-Up
- PA 522 Week 2: Feedback Axis Explainer
- PA 520 Week 2: Spirometry Interpretation
PA 528 Week 2 questions, answered
Is a diagram required?
Rarely, though many sections accept one and a few supply the grid themselves. What carries the marks is the written reasoning attached to each finding, so an example keeps the argument legible in prose even where a figure is included. If your classroom hands out a specific form, send it and the example is filled into that form rather than a substitute.
Does the example name the disease as well as the site?
Only where the instructions ask. When they do, the condition appears after the site and is tied to it, usually as two or three candidates that the named anatomy permits, with the feature separating them stated. When they do not, the example stops at the localization and the confirming study, which is what the marking rewards in this week.
Can the example use the same abbreviations my classroom uses?
Yes, and it is worth sending them. Neurological shorthand differs between programs, with reflex grading, strength scales and the way laterality is abbreviated all written more than one way. An example that uses your classroom's conventions reads as belonging to your section, and a grader is not slowed down translating a notation nobody there uses.
Where can I find a free PA 528 Week 2 sample paper?
The full PA 528 Week 2 localization exercise is on this page, nine deficits mapped to the right frontoparietal cortex with the brainstem ruled out.
How does the PA 528 Week 2 sample exclude the brainstem?
There are no crossed findings, and the gaze preference is overcome by turning the head, which shows the brainstem gaze centers work.