27th February 2025

A 67-year-old woman is rushed to hospital by her husband as she has become more confused throughout the day.

A 67-year-old woman is rushed to hospital by her husband as she has become more confused throughout the day. The husband describes that his wife has been complaining of constipation and non-specific pains and aches for the past week but thought this was likely a side effect of her chemotherapy.

She has known breast cancer and has been undergoing treatment with a combination of chemotherapy, radiotherapy, and steroids.

On presentation to the emergency department, she is drowsy, with a GCS of 12 (E3 M5 V4). Her NEWS (National Early Warning Score) is 1 (SpO2 95%), and all other observations are within normal ranges. Initial examination is unremarkable.

Which investigation is most appropriate and likely to reveal the cause of this lady’s presentation?