Q. A 30 year-old female presents to the emergency room with acute lower leg weakness and back pain that started 2 hours ago. She denies any weakness or pain in her hands. She denies any recent spine injury, falls, fevers, chills, or illicit drug use. Her vitals are as follows: blood pressure 160/70 mmHg, heart rate 75, temperature 37.5°C, respiratory rate 12, oxygen saturation 95%. Patient is alert and awake. Her cranial nerves are intact. Strength is 5/5 in the upper extremities and 0/5 in the lower extremities. Reflexes are 2+ in the upper extremities and 0 in the lower extremities. Vibration and proprioception sensations are normal in all extremities. Pain and temperature sensations are absent in the lower extremities. Plantar reflexes are absent bilaterally. The patient’s presentation is concerning for a spinal cord infarction. What is the most likely location of the infarct in this clinical scenario?

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