16th August 2024

A 45-year-old man is brought to the Emergency Department following a series of seizures at home

A 45-year-old man is brought to the Emergency Department following a series of seizures at home. He is unable to give a history due to being obtunded, however a collateral history from his GP yields that he has contacted them several times in the preceding weeks complaining of episodes of slurred speech. His partner reports that he has been more confused in the last 48 hours and has lost weight in recent months.

He is known to be a user of IV drugs, and there are recent track marks in his antecubital fossae.

An urgent full blood count is returned:

A CT head is performed and demonstrates a hyperdense lesion in the periventricular white matter. The radiographers have carried out a post-contrast scan having noted this lesion on the initial unenhanced scan; this demonstrates avid, but irregular, contrast enhancement. There is a small rim of vasogenic oedema but no mass effect.

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