A 45-year-old man was brought by ambulance to the ER after stumbling into the diner where he typically had breakfast, and falling. He has a history of alcohol use, cigarette smoking, and hypertension. At the ER, his vital signs were WNL except his blood pressure, which was high (218/116). His lungs were clear, heart rate was normal, abdomen was soft and not tender, and he exhibited no swelling in his extremeties. A neurological exam revealed that he was alert but could only grunt. He produced no words. He followed verbal commands to close his eyes and open his mouth, but no others. He exhibited decreased movment of the face, and no right arm movement except for flexion in response to a painful stimulus. He could raise his legs off the bed, but could not raise his right leg against resistance. 1. On the basis of signs and symptoms describe above, where is the lesion? Be as specific as possible and justify your answer. 2. What is the most likely diagnosis? Be as specific as possible and justify your answers. 3. As there has been no neuroimaging or other diagnostic tests done at this point, what other possible etiologies (besides the diagnosis in #2)? Justify your answers. 4. Look at the 4 MRIs provided on the following pages. The lightened portion shows the area of damage. On all views, the right side of the picture is the left side of the brain. a. Which picture is most likely the one belonging to this patient? Explain your answer, including reasons for choosing the MRI you chose. b. For each of the remaining 3 MRIs, explain why you rule it out.
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