Patient Case: A 70-year-old right-handed woman is brought to the emergency department with sudden-onset left-sided weakness. Her family reports that she has been ignoring objects on her left side, even when eating or brushing her hair. On examination, she has left-sided hemiparesis and hemisensory loss. When asked to draw a clock, she only fills in the numbers on the right side. A CT scan confirms an infarction in the right MCA territory. Question: What is the most likely cognitive deficit in this patient?

A 65-year-old man presents to the emergency department with sudden-onset weakness in his right arm and face. His wife reports that he was unable to speak coherently and appeared confused before arriving at the hospital. He has a history of hypertension and atrial fibrillation. On examination, he has right-sided hemiparesis (arm and face more affected than leg), right-sided sensory loss, and non-fluent speech. A CT scan of the head shows an infarction in the left middle cerebral artery (MCA) territory. Question: Which of the following best explains the patient’s inability to speak?

A 67-year-old man with a history of hypertension, atrial fibrillation, and diabetes mellitus is brought to the emergency department after sudden-onset right-sided weakness and slurred speech. On examination, he has: •Right-sided facial droop and arm weakness (muscle strength: 1/5 in the right arm, 3/5 in the right leg) •Mild right leg weakness •Right-sided sensory loss •Leftward gaze preference A non-contrast CT scan shows an ischemic stroke in the left cerebral hemisphere. Question: Which artery is most likely affected in this patient?

Chief Complaint: A 29-year-old woman with a known diagnosis of relapsing-remitting multiple sclerosis (RRMS) presents to the emergency department with worsening left leg weakness and urinary incontinence over the past three days. History of Present Illness: The patient reports that three days ago, she began experiencing progressive weakness in her left leg, making it difficult to walk. Over the past 24 hours, she has also noticed urinary urgency and occasional incontinence, which she has not previously experienced. She denies fever, recent infections, or new medications. She recalls similar episodes in the past, including optic neuritis a year ago, where she experienced painful vision loss in her right eye, which resolved after a few weeks with treatment. Her symptoms have historically followed a relapsing-remitting pattern, with periods of worsening symptoms followed by partial or complete recovery. She admits to feeling more fatigued than usual and has mild tingling in her hands. She works as a software developer and has struggled with concentration and memory over the last few weeks, though she attributed it to stress. Past Medical History: Relapsing-remitting multiple sclerosis (RRMS), diagnosed 3 years ago. Prior episodes of optic neuritis and numbness in the right arm. No other chronic illnesses. Medications: Interferon-beta (Disease-modifying therapy) Baclofen (for spasticity) Review of Systems: Neurologic: Progressive left leg weakness, mild tingling in hands, cognitive fog Genitourinary: Urinary urgency and incontinence Ophthalmologic: No current visual symptoms Constitutional: Increased fatigue Physical Examination: Vital Signs: BP 118/76 mmHg, HR 82 bpm, Temp 98.6°F Neurologic Exam: Left leg weakness (4/5 power) with hyperreflexia Positive Babinski sign on the left Positive Lhermitte’s sign (electric shock-like sensation down the spine with neck flexion) Mild difficulty with tandem gait No meningeal signs, normal cranial nerve function Diagnostic Workup: MRI Brain and Spine (with contrast): New contrast-enhancing periventricular white matter lesions, consistent with active demyelination. Lumbar Puncture (CSF Analysis): Elevated IgG index and oligoclonal bands. Urinalysis: No signs of urinary tract infection (UTI). What is the most appropriate acute treatment for her current exacerbation?