26th February 2025

A 75-year-old lady presents with a three-week history of left hand weakness and right leg paraesthesia

A 75-year-old lady presents with a three-week history of left hand weakness and right leg paraesthesia. This is on a background of a two-month history of severe headaches with associated nausea and vomiting. She has no neck or back pain. She has a background of metastatic breast cancer, for which she takes letrozole. She has no other past medical history of note.

An MRI of the head and spine with contrast is performed. This reveals multiple intracranial ring-enhancing lesions, each with a large degree of surrounding perilesional oedema. Her MRI spine shows some degenerative changes in her L2 vertebra, no other spinal lesions and preserved spinal cord signal throughout.

What would be your first step in the emergency management of this patient?

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