18th August 2024

An 82-year-old gentleman is brought in from his nursing home because of new onset right-sided weakness

An 82-year-old gentleman is brought in from his nursing home because of new onset right-sided weakness and worsening confusion and urinary incontinence. He was well the day before according to the nursing home notes. He has a history of a right lacunar infarct two years earlier with minimal residual deficit, dementia, hypertension and COPD. On examination, you note that he has weakness of his left arm and leg with dysmetria and ataxia of both arm and leg. He has an extensor plantar. He also has some suprapubic tenderness. He is disorientated, febrile and appears delirious. What is the likely cause of this gentleman’s neurological disturbance?

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