| Course | PA 528 Comprehensive Clinical Module Neurology |
|---|---|
| Week | 7 |
| Paper type | Stroke syndrome correlation |
| Length | About 820 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 7
Stroke Syndrome Correlation: B.T.'s Deficits Walked Into the Superior Division of the Right Middle Cerebral Artery, Cortical Signs Weighed Against Deep Ones and a Mildly Weak Leg That Does Not Quite Fit
Student Name
Chamberlain University
PA 528: Comprehensive Clinical Module Neurology
Instructor Name
Month Day, Year
Stroke Syndrome Correlation: B.T.'s Deficits Walked Into the Superior Division of the Right Middle Cerebral Artery, Cortical Signs Weighed Against Deep Ones and a Mildly Weak Leg That Does Not Quite Fit
Deficits in Anatomical Language
Left lower facial weakness sparing the forehead. Left arm weakness, grade 3, distal worse than proximal. Left leg weakness, grade 4. Left-sided loss of pinprick, position sense and two-point discrimination in the hand. Extinction of the left side on double simultaneous stimulation, tactile and visual. Rightward gaze preference overcome by head turning. Dysarthria without errors of language. NIH Stroke Scale 9 on arrival, 6 at 24 hours.
One Artery, Named
The right middle cerebral artery, superior division. CT angiography at two hours showed a cutoff of the superior division beyond the main trunk, and the next day's MRI showed restricted diffusion over the right lateral frontal lobe and the anterior parietal lobe, sparing the temporal lobe and the deep gray nuclei.
Walking the Deficits Into the Territory
The superior division supplies the lateral frontal lobe, including the motor strip for face and arm and the frontal eye field, and the anterior parietal lobe, including the sensory strip for face and arm. Face and arm weakness: lateral motor strip. Face and arm sensory loss with poor two-point discrimination: lateral sensory strip, a cortical sensory deficit. Gaze preference toward the right: the right frontal eye field, which drives the eyes to the left, is out of action, so the left frontal eye field pushes them to the right. Extinction: the right parietal attention network, which is dominant for attention to both sides of space in most right-handed people. Dysarthria: the corticobulbar fibers to the lips and tongue.
Cortical Against Deep
Cortical signs are present: extinction, gaze preference and cortical sensory loss. A purely deep stroke, such as a lacunar infarct in the internal capsule, would produce weakness of face, arm and leg in equal measure without these signs. The imaging confirms that the infarct is cortical and subcortical, sparing the basal ganglia and internal capsule, which matches the clinical prediction.
The Deficits That Do Not Fit
The left leg is mildly weak. The leg area of the motor strip lies near the midline, in the territory of the anterior cerebral artery, which is not involved. Two explanations are possible: swelling around the infarct in the first days, affecting fibers that run from the leg area through the white matter beneath the infarct, or involvement of descending fibers in the corona radiata, which the superior division's deep branches supply. The leg improved from grade 4 to near normal by day 7, which favors swelling. The deficit that does not fit is recorded, not ignored.
Why Not the Inferior Division or the Whole Artery
An inferior division infarct in the right hemisphere would cause more neglect and a left visual field cut, with less weakness. An occlusion of the whole middle cerebral artery trunk would cause dense weakness, a field cut and severe neglect, often with gaze deviation that cannot be overcome. B.T.'s pattern fits the superior division best.
The Mechanism
B.T. has a pacemaker for sick sinus syndrome, which can coexist with atrial fibrillation, and three earlier transient episodes. The pacemaker's records showed several episodes of atrial fibrillation lasting up to four hours in the preceding months. An embolus from the heart lodging in a branch of the middle cerebral artery fits both the sudden onset and the branch occlusion. The secondary prevention guideline recommends oral anticoagulation for patients with stroke and atrial fibrillation (Kleindorfer et al., 2021), and apixaban was started on day 4 after imaging showed no bleeding.
The Study, With a Question
Carotid duplex ultrasound was requested with one question: is there a narrowing of 50 percent or more in the right internal carotid artery, which would make an artery-to-artery embolus a competing mechanism and could call for carotid surgery? It showed less than 50 percent narrowing on both sides, supporting the heart as the source. The acute guideline's recommendation to image the extracranial arteries in patients with ischemic stroke frames the request (Powers et al., 2019).
What the Correlation Leaves for Rehabilitation
Because the infarct spares the deep nuclei and the leg area, the outlook for walking is good, and the leg had nearly recovered by day 7. Hand function and neglect are the deficits most likely to limit independence; neglect, from the right parietal involvement, also affects safety in the kitchen and on the road. The rehabilitation team was given the map of involved regions so therapy could target attention to the left side and fine hand use.
References
Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Jr., Turan, T. N., & Williams, L. S. (2021). 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke, 52(7), e364-e467. https://doi.org/10.1161/STR.0000000000000375
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
What the PA 528 Week 7 assignment asks for
Week seven asks you to correlate a stroke syndrome with its arterial territory. Begin with a block listing the deficits as found, with sides, in anatomical language. Name one artery, or one branch, and give the evidence for it. Then walk the deficits into that territory one structure at a time, saying which cortical or deep region each implicates. Weigh cortical against deep involvement and explain the evidence. Give the deficits that do not fit their own section and the most likely reason for each. Explain why neighboring territories or a larger vessel fit less well. Address the likely mechanism. End with a study framed around a specific question. Use headings, keep the clinical and anatomical parts distinct, and cite the guidelines you use.
Inside the PA 528 Week 7 example
The deficit block lists left lower facial weakness, a grade 3 arm, a grade 4 leg, cortical sensory loss, extinction, gaze preference and dysarthria, with Stroke Scale scores of 9 and 6. The artery section names the right MCA superior division and reports the angiographic cutoff and the MRI distribution. Each deficit is walked into the lateral frontal and anterior parietal cortex, including the frontal eye field and the parietal attention network. Cortical signs and the spared deep nuclei are weighed against a lacunar alternative. The mild leg weakness is explained by swelling or corona radiata fibers, favored by recovery by day 7. The inferior division and the whole trunk are argued out. Pacemaker-detected atrial fibrillation supports embolism and apixaban, citing Kleindorfer, and carotid ultrasound answers a 50 percent stenosis question. A rehabilitation section closes.
Where the points sit in the PA 528 Week 7 rubric
Most of the credit on this correlation follows the walk from deficits to territory. Naming an artery without mapping each deficit to a structure within it loses the largest share. Faculty next check that deficits are listed in anatomical language with sides, and that one artery is chosen rather than a list. The cortical-versus-deep section earns significant marks when it uses specific signs. A deficit that does not fit must be named and explained; ignoring it is a frequent deduction. Arguing against neighboring territories adds credit. The mechanism section is graded for supporting evidence. The closing study must carry a specific question. Headings that keep clinical and anatomical parts distinct are part of the format, with guidelines cited.
PA 528 Week 7 help from the desk
Correlation papers often lose marks when students name the artery early and then list deficits without tying each to a structure. Pass along your patient's deficits and imaging, and the paper written for you would list the deficits anatomically, name one artery with its evidence and walk each deficit into a specific region of that territory. Cortical and deep involvement are weighed with named signs. Any deficit that does not fit gets its own explanation. Neighboring territories are argued out, the mechanism is addressed and a study is requested with a single question. If your case is a posterior circulation or lacunar syndrome, the same approach applies. Compare every deficit and finding with your own case before adapting the argument.
Get a PA-528 Week 7 example written to your instructions
Send the case, the rubric and any required headings, and a custom stroke syndrome correlation written to that patient comes back inside 24-48h, the first one free. Say whether your section expects a named syndrome or only the territory, because the two versions are built differently from the first paragraph onward.
More PA 528 papers and MPAS samples
- PA 528 Week 1: Lesion Localization Post
- PA 528 Week 2: Lesion Localization Exercise
- 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 8: Neuroimaging Request Brief
- PA 526 Week 7: Endoscopy Indication Write-Up
- PA 524 Week 7: Urinary Obstruction Brief
- PA 522 Week 7: Adrenal Incidentaloma Workup
- PA 520 Week 7: 6-Minute Walk Test Report
PA 528 Week 7 questions, answered
Does the brief have to name a specific artery?
Almost always, and naming a general region instead is where these assignments lose their point. The correlation only works if a named territory can be checked against the deficits one by one. Where the case genuinely allows two vessels, the example names both, says which it favors, and gives the observation that would settle the choice.
How much of the vascular anatomy should be explained?
Just the part carrying the argument. A paragraph rehearsing the circle of Willis earns little, because it would sit identically in any classmate's paper. What earns marks is the sentence connecting one structure in that territory to one deficit in this case, repeated for each deficit until the list is used up.
Can the example include a diagram of the territory?
It can where your section allows figures, though most of these assignments are marked on prose. A small labeled figure helps only when it shows the specific structures under discussion; a general circulation diagram copied from a textbook adds nothing a grader can credit. Send your requirements and the example includes a figure only if it earns its place.
Where can I find a free PA 528 Week 7 sample paper?
This page carries the full PA 528 Week 7 correlation, deficits walked into the superior division of the right middle cerebral artery with a misfit leg explained.
Why does the mildly weak leg not quite fit in the PA 528 Week 7 sample?
The leg area lies in anterior cerebral artery territory, which was spared, so the weakness is explained by swelling or deep fibers and it recovered by day 7.