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submitted by hayayah(382),

The damage is in the L midbrain in the area affecting the corticospinal tract. Because it is in the midbrain, decussation in the pyramids (medulla) so it will show ipsilateral dysfunctional motor signs.

Photo of midbrain and important areas: shorturl.at/myHLR

masonkingcobra  Just for clarification, on the left side, you see where he had the infarction 7 years ago and the tissue is gone. +1  
chefcurry  so is the dysfunction on the contralateral side? +  
praderwilli  If the decussation is in the pyramids of the medulla, shouldn't it be contralateral hemiparesis if the damage is on the right? It confuses me because of the labeling right and left at the top of the pictures. +  
endochondral1  that link isnt working @ hayayah....is there any good picture to look at to know where the tracts are on this section? +  


submitted by xxabi(88),

I was under the impression that this was an aortic dissection, due to "severe chest pain" as well as the false lumen in the aorta. And HTN is the #1 risk factor for aortic dissection. Someone correct me if i'm wrong, but I think this is aortic dissection rather than aortic aneurysm.

chefcurry  I believe so, FA 2018 pg 299 +2  
ergogenic22  It is dissection "extra lumen in the media of the proximal aorta" = "a longitudinal intimal (tunica intima) tear with dissection of blood through the media of the aortic wall" ... answer is still hypertension +  
breis  FA 2019: 301 +