Question
A 40-year-old man was found to have weakness of the right shoulder and arm 6 hours before presentation. This was followed by weakness of the ipsilateral leg, then left leg, followed by left arm (around-the-clock pattern). Where in the neuraxis is the lesion likely to be present?
This question was previously asked in
UPSC CMS 2026 Surgery, Gynaecology & Obstetrics, and PSM Question Paper (02-Aug-2026)
The correct answer is
Foramen magnum
A sequential 'around-the-clock' pattern of limb weakness spreading from one arm to the ipsilateral leg, then to the contralateral leg and finally the contralateral arm is a classic localizing sign of a lesion at the craniocervical junction/foramen magnum, related to the crossing pattern of corticospinal tract fibres at that level.
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