A 59-year-old man is brought to the emergency department by his wife for a 1-hour history of sudden behavior changes. They were having lunch together when, at 1:07 PM, he suddenly dropped his sandwich on the floor. Since then, he has been unable to use his right arm. She also reports that he is slurring his speech and dragging his right foot when he walks. Nothing like this has ever happened before. The vital signs include: pulse 95/min, blood pressure 160/90 mm Hg, and respiratory rate 14/min. The physical exam is notable for an irregularly irregular rhythm on cardiac auscultation. On neurological exam, he has a facial droop on the right half of his face but is able to elevate his eyebrows symmetrically. He has 0/5 strength in his right arm, 2/5 strength in his right leg, and reports numbness throughout the right side of his body. Angiography of the brain will most likely show a lesion in which of the following vessels?
APosterior cerebral artery
BInternal carotid artery
CMiddle cerebral artery
DBasilar artery
EAnterior cerebral artery
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 76-year-old woman with hypertension and coronary artery disease is brought to the emergency department after the sudden onset of right-sided weakness. Her pulse is 83/min and blood pressure is 156/90 mm Hg. Neurological examination shows right-sided facial drooping and complete paralysis of the right upper and lower extremities. Tongue position is normal and she is able to swallow liquids without difficulty. Knee and ankle deep tendon reflexes are exaggerated on the right. Sensation to vibration, position, and light touch is normal bilaterally. She is oriented to person, place, and time, and is able to speak normally. Occlusion of which of the following vessels is the most likely cause of this patient's current symptoms?
AIpsilateral anterior cerebral artery
BContralateral middle cerebral artery
CAnterior spinal artery
DContralateral lenticulostriate artery
EIpsilateral posterior inferior cerebellar artery
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