A 65-year-old right-handed treated hypertensive female patient presents with acute onset of altered sensorium , right-sided weakness and inability to speak. Physical exam reveals blood pressure 188/98, respiration 15 per minute and pulse 88. She has no strength in her right arm and right leg which exhibit increased deep tendon reflexes and increased tone. There is a right-sided Babinski’s and her eyes deviate to the left. She is unable to speak. Bilateral carotid bruits are present. Laboratory studies reveal normal CBC and coagulation studies; normal glucose, electrolytes and calcium, elevated cholesterol and triglyceride and normal urinalysis. An EKG revealed normal sinus rhythm.

The following images were obtained (CT-scans)

1. Based on the above information, what is the most likely diagnosis of this patient:

A. A cerebral infarct in the left middle cerebral artery territory.

B. A cerebral infarct in the right anterior cerebral artery territory.

C. A cerebral infarct in the right middle cerebral artery territory.

D. A cerebral infarct in the left anterior cerebral artery territory.

E. A cerebral infarct in the left posterior cerebral artery territory.

2. The most likely etiology of this patients disease process is:

A. Left-sided neck trauma with fat embolism

B. Mucormycosis vasculitis

C. Primary granulomatous angiitis of the nervous system

D. Atherosclerotic vascular disease.

E. Hypercoagulable state secondary to pancreatic cancer

3. The disease process in this patient is frequently associated with:

A. Hypertension

B. Diabetes mellitus

C. Hyperlipidemia

D. Smoking

E. All of the above

4. Hemorrhagic (red) cerebral infarcts:

A. Are typically not associated with embolic events

B. Are typically treated with anticoagulants

C. Are red and hemorrhagic due to reperfusion of damaged vessels

D. Exhibit the same histologic features and evolution of an anemic (nonhemorrhagic) infarct.

5. The following is a gross photograph of an autopsy specimen from a patient with a similar disease process:

Which one of the following statements best describes the histologic morphologic changes, which occur in a patient with the disease process depicted in this image:

A. Ischemic pink neurons may be seen approximately 12 hours after tissue insult occurs.

B. Phagocytic cells (microglia, monocytes and histiocytes) are the predominant inflammatory cells present in this process 12-24 hours after the tissue insult.

C. Neutrophilic infiltrates develop in the first 6-12 hours after tissue insult and remain present until day 12-14 after tissue insult.

D. Reactive gliosis develops within 1-4 hours after tissue insult.

E. All of the above are true statements.

6. Which of the following clinical features may be seen in a left middle cerebral artery occlusion with cerebral infarction:

A. Right-sided hemiplegia

B. Deviation of eyes to the left

C. Global aphasia

D. right homonymous hemianopia

E. All of the above