13th February 2025

A 63-year-old gentleman is brought to A&E by his daughter.

A 63-year-old gentleman is brought to A&E by his daughter. She says that he has been in pain for two weeks but intensely dislikes hospitals and has, therefore, remained at home, “hoping it will get better”. Today, he can barely open his eye due to pain, and she has persuaded him to come in.

She says that he has no past medical history and is usually fit and well. He had a childhood reaction to penicillin. He is originally from Mexico but has lived in the UK for the past fifteen years.

He is hunched forwards, covering his eyes from the light, and evidently in significant pain.

Observations are as follows: HR 105 bpm, BP 135/70 mmHg, RR 17, temperature 38.2℃.

CT brain is abnormal, and an MRI performed to characterise the abnormality shows the following:

What is the likely diagnosis?

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