4th March 2024

A 39-year-old male with known sensorineural hearing loss presents to the acute medical unit

A 39-year-old male with known sensorineural hearing loss presents to the acute medical unit with a new onset generalised tonic-clonic seizure. MRI showed evidence of global involutional changes with old infarcts in his left parietal lobe, left insular lobe and right cerebellum. Neurological examination today showed a longstanding left-sided upper and lower limb dyspraxia and a right homonymous hemianopia. Blood tests were performed, and this was unremarkable apart from a raised venous lactate at 4.6mmol/L ( normal 0.5-2.2mmol/L).

What is the likely underlying diagnosis for this gentleman?

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