A 61-year-old man is brought to the emergency room with slurred speech. According to the patient's wife, they were watching a movie together when he developed a minor headache. He soon developed difficulty speaking in complete sentences, at which point she decided to take him to the emergency room. His past medical history is notable for hypertension and hyperlipidemia. He takes aspirin, lisinopril, rosuvastatin. The patient is a retired lawyer. He has a 25-pack-year smoking history and drinks 4-5 beers per day. His father died of a myocardial infarction, and his mother died of breast cancer. His temperature is 98.6°F (37°C), blood pressure is 143/81 mmHg, pulse is 88/min, and respirations are 21/min. On exam, he can understand everything that is being said to him and is able to repeat statements without difficulty. However, when asked to speak freely, he hesitates with every word and takes 30 seconds to finish a short sentence. This patient most likely has an infarct in which of the following vascular distributions?
AProximal middle cerebral artery
BInferior division of the middle cerebral artery
CMiddle cerebral artery and posterior cerebral artery watershed area
DSuperior division of the middle cerebral artery
EAnterior cerebral artery and middle cerebral artery watershed area
A 72-year-old woman comes to the emergency department 1 hour after the sudden onset of a diffuse, dull, throbbing headache. She also reports blurred vision, nausea, and one episode of vomiting. She has a history of poorly controlled hypertension. A photograph of her fundoscopic examination is shown. Which of the following is the most likely underlying cause of this patient's symptoms?
AHemorrhagic lacunar stroke
BTransient ischemic attack
CGiant cell arteritis
DHypertensive emergency
EEpidural hematoma
A 28-year-old man is brought to the emergency department by ambulance after developing an altered mental state following blunt trauma to the head. The patient was competing at a local mixed martial arts competition when he was struck in the head and lost consciousness. A few minutes later, upon regaining consciousness, he had a progressive decline in mental status. Past medical history is noncontributory. Upon arrival at the hospital, the temperature is 37.0°C (98.6°F), the blood pressure is 145/89 mm Hg, the pulse is 66/min, the respiratory rate is 14/min, and the oxygen saturation is 99% on room air. He is alert now. A noncontrast CT scan is performed, and the result is provided in the image. Which of the following structures is most likely affected in this patient?
ASubarachnoid space
BSuprasellar cistern
CMiddle Meningeal artery
DVentricular system
EBridging veins
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