HY USMLE Q #737 – Cardio / Neuro

A 66-year-old man is brought to hospital following a 12-hour history of weakness of his left arm and face. Three weeks ago, he had a myocardial infarction and spent one week in hospital. He has a 10-year history of type II diabetes mellitus managed with metformin and glyburide. He has smoked one pack of cigarettes daily for 40 years. Blood pressure is 125/80. Which of the following is the most likely explanation for this patient’s acute presentation?

Carotid stenosis
Embolus from a ventricular aneurysm
Left ventricular free wall rupture
Paradoxical embolus
Vertebral artery dissection