A 42 year old previously healthy female has sudden weakness develop on the left. She also reports a severe headache. A head CT scan reveals a 2.5 cm hemorrhage involving the region of the right basal ganglia. A cerebral angiogram demonstrates occlusion of the right middle cerebral artery. He is admitted with increasing headache over a day along with fever.
Physical examination reveals nuchal rigidity.
A 79 year old retired banker has had a long history of transient ischemic attacks. However, he can recognize all family members and can talk at length about events of the past. He can still feed and clothe himself. A serum specimen is obtained from the mother of a fetus after an ultrasound performed at 18 weeks reveals a lower lumbar neural tube defect. He is afebrile.