A 65-year-old male presents to the emergency room complaining of a severe headache. He developed a sudden-onset severe throbbing headache while watching a football game on television. His past medical history is significant for migraines and hypertension; however, he states that this headache is different from his normal migraine headaches. He has a 30 pack-year smoking history. His family history is notable for stroke in his mother and father. His temperature is 98.9°F (37.2°C), blood pressure is 150/90 mmHg, pulse is 100/min, and respirations are 14/min. On examination, he is oriented to person, place, and time. Neck motion is limited due to pain. Strength is 5/5 bilaterally in both the upper and the lower extremities and sensation is grossly intact across all the dermatomal distributions. Patellar, brachioradialis, and Achilles reflexes are 2+ bilaterally. The vessel that is most commonly involved in this patient's likely condition directly branches off which of the following vessels?
AMiddle cerebral artery
BMaxillary artery
CAnterior cerebral artery
DPosterior cerebral artery
EInternal carotid artery
A 72-year-old man with longstanding history of diabetes mellitus and hypertension presents to the emergency department with sudden-onset numbness. On your neurological exam, you note that he has loss of sensation on the left side of his face, arm, and leg. His motor strength exam is normal, as are his cranial nerves. Which of the following is the most likely explanation for his presentation?
AMiddle cerebral artery stroke
BThalamic stroke
CConversion disorder
DAnterior cerebral artery stroke
EBasilar artery stroke
A 35-year-old man who suffered a motor vehicle accident 3 months ago presents to the office for a neurological evaluation. He has no significant past medical history and takes no current medications. He has a family history of coronary artery disease in his father and Alzheimer’s disease in his mother. On physical examination, his blood pressure is 110/60 mm Hg, the pulse is 85/min, the temperature is 37.0°C (98.6°F), and the respiratory rate is 20/min. Neurological examination is suggestive of a lesion in the anterior spinal artery that affects the anterior two-thirds of the spinal cord, which is later confirmed with angiography. Which of the following exam findings would have suggested this diagnosis?
ALoss of vibratory sense below the level of the lesion
BLoss of pain and temperature sensation above the level of the lesion
CNegative plantar extensor response in his lower limbs
DFlaccid paralysis on the right side
EPreserved pressure sensation
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