13th November 2020

A 79-year-old lady is admitted to hospital with a 2-week history of confusion and recurrent falls

A 79-year-old lady is admitted to hospital with a 2-week history of confusion and recurrent falls. Her observations are within normal limits, and there is no drop-in blood pressure on lying-standing. She scores 5 out of 10 on Abbreviated Mental Test Score (AMTS) and is not known to be confused normally. Her initial full blood count, white cell count, urea and electrolytes are all unremarkable. She has a past medical history of hypertension, osteoarthritis, previous myocardial infarction, breast cancer (conservatively managed) and pulmonary fibrosis. Over the next few days, she becomes even more confused and complains of nausea and vomiting, to the point where she no longer has enough oral intake. A computed tomography scan of the head is performed to rule out any cause of her confusion, and several small space-occupying lesions are noted. 

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