National Physical Therapy Examination (NPTE) Practice Exam

What is the MOST LIKELY location of infarct for a patient with R homonymous hemianopsia and right hemiparesis?

1. R MCA

2. R PCA

3. L PCA

4. L MCA

The correct answer is: L PCA

The presentation of right homonymous hemianopsia and right hemiparesis suggests an issue linked to the brain's vascular supply, specifically the areas that correspond with visual fields and motor control. Right homonymous hemianopsia indicates a loss of vision in the right visual field, affecting both eyes, and suggests damage to the visual pathways, which are primarily supplied by the posterior cerebral artery (PCA). In this scenario, the infarct would likely occur due to a loss of blood flow to regions responsible for processing vision. Right homonymous hemianopsia occurs with lesions affecting the left occipital lobe or the optic tract, which corresponds to the PCA territory. The right hemiparesis (weakness on the right side of the body) suggests involvement of the motor cortex, typically located in the left hemisphere, which is supplied by the middle cerebral artery (MCA). The key point here is recognizing that the infarcted area could be in the left PCA territory affecting the visual fields, leading to right homonymous hemianopsia, along with the proximal motor areas being supplied by the left MCA, potentially causing right hemiparesis. The left PCA involvement could encompass both visual processing areas and impact related motor functions