18th August 2024

A 78-year-old man is found on the floor in his nursing home. He has a background of dementia

A 78-year-old man is found on the floor in his nursing home. He has a background of dementia, chronic obstructive pulmonary disease, hypertension and osteoarthritis and his nurse reports he has lost 5 kg in weight in the last two months. He was well when she gave him breakfast and then returned 10 minutes later to find him on the floor. He was wet and she was unable to rouse him initially. On examination, he is drowsy but rousable to voice. There is mild weakness on his right hand side with reduced sensation. He is aphasic, has slurred speech and has gaze deviation. His temperature is 37.8 and his blood sugar is 5 mmol/L. He has a plain CT head that demonstrates no haemorrhage but there are two ring-enhancing lesions seen on CTA. What is the most likely cause of this patient’s presentation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.