Cerebral vascular disease Quiz: Ace Your Exams

A 78-year-old right-handed man is brought to the emergency department following sudden-onset weakness in his right arm and inability to speak for twenty four hours. The patient’s daughter states she initially became concerned when he dropped his cup of coffee while walking to the kitchen table last night. The daughter states he has had a similar episode in the past that resolved spontaneously. He has a history of hypertension, for which he takes lisinopril. His temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 158/104 mmHg. The patient is alert and visibly frustrated by not being able to speak. Physical examination reveals 2/5 strength in the right upper extremity and 4/5 strength in the right lower extremity. He follows written and verbal commands but is unable to speak or write. MRI of the head demonstrates ischemic changes in the cerebral territory supplied by the left middle cerebral artery. Which of the following histopathological findings are most likely to be observed in this patient’s brain at the present time?