A 52-year-old male wakes up with severe neck stiffness and headache. His eyes are deviated to the left. What do you suspect?

The symptoms described in the scenario—severe neck stiffness, headache, and left eye deviation—are indicative of a neurological event, particularly a stroke. The severe neck stiffness suggests irritation of the meninges, which is commonly associated with conditions like meningitis, but when combined with the acute headache and the neurological signs of eye deviation (which may indicate cranial nerve involvement), a stroke becomes a strong consideration.

In a stroke, particularly a right-sided cerebrovascular accident (CVA), you could see signs such as eye deviation towards the lesion or weakness on the opposite side of the body. The headache can also be consistent with a cerebrovascular event that is presenting acutely.

Other conditions, while they may produce some overlapping symptoms, do not account for the acute presentation and the combination of neurological findings. A spinal cord tumor, for instance, could produce symptoms over time, but it is less likely to present with such acute onset of severe headache and neck stiffness in this manner. Bell's palsy typically involves facial muscle weakness rather than the neck stiffness and headache seen here. Chronic meningitis would usually present more insidiously and not with the sudden severity described.

Thus, the symptoms align strongly with an acute ischemic event, making stroke the most