Review Question - QID 210572

A 57-year-old man presents to the emergency department for right-sided weakness and slurred speech. He was eating breakfast with his wife when he acutely developed difficulty holding his fork in his right hand and slurring of speech. He eventually fell to the ground on a carpeted floor. His past medical history is significant for hypertension, hypercholesterolemia, multiple episodes of epistaxis, migraine headaches, and iron deficiency anemia. His father died from a hemorrhagic stroke when he was 60 years of age and had gastrointestinal bleeding. His temperature is 99°F (37.2°C), blood pressure is 157/98 mmHg, pulse is 92/min, and respirations are 13/min. On physical exam, he has a right-sided weakness, slurred speech, and is aphasic. He also has a finding demonstrated in Figure A. Laboratory testing is significant for a hemoglobin of 20 g/dL and a hematocrit of 60%. An electrocardiogram demonstrates sinus rhythm with mild tachycardia. A non-contrast head CT is shown in Figure B. Which of the following is most likely the cause of this patient's symptoms?