Anatomy clinical correlates Quiz: Ace Your Exams

A 68-year-old, right-handed man is brought to the emergency department to evaluate sudden onset weakness. The patient awoke with left-hand clumsiness that rapidly progressed to left-sided weakness, affecting the left arm more than the left leg. Past medical history is significant for hypertension, type 2 diabetes mellitus, and hyperlipidemia. The patient’s last refill of medications was one year ago. He has smoked one pack of cigarettes per day for the past 40 years. Temperature is 37.3°C (99.1°F), pulse is 98/min, respirations are 20/min and blood pressure is 200/110 mm Hg. On physical examination, the patient has slurred speech, left-sided facial weakness sparing the forehead, 2/5 muscle strength in the left upper limb, and 4/5 muscle strength in the left lower limb. Right-sided strength and sensation are normal. A right-sided infarct localized to the paramedian pontine base is seen on MRI. Which of the following additional findings will likely be observed in this patient?