A 79-year-old man on apixaban for atrial fibrillation is brought in by his wife. Over three weeks he has become slower, sleeps much of the day, has twice lost the thread of conversations, and has been unsteady walking with two near-falls. She recalls that four weeks ago he struck his head on a kitchen cupboard, without losing consciousness, and had a headache for a day. He has no fever and no urinary symptoms. Examination: Glasgow Coma Scale 14 (confused), mild drift of the right arm when held outstretched, brisk right-sided reflexes, and a normal gait apart from unsteadiness.
Which one of the following is the most likely diagnosis?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from Neurology
See allA 45-year-old man wakes to find the left side of his face drooping. When he tries to raise his eyebrows only the right side moves, and he cannot fully close his…
Clinical rotations · common
A 41-year-old woman presents with a headache that began abruptly while she was lifting weights at the gym yesterday evening, reaching maximum intensity within s…
Clinical rotations · common
A 24-year-old woman is brought to the emergency department after drinking approximately 8 L of water during a long-distance event. She is drowsy and has a serum…
Clinical rotations · common
A 59-year-old man suddenly develops difficulty speaking and weakness of the right arm while driving. His wife reports that, immediately beforehand, the right si…
Clinical rotations · common
A 63-year-old woman has three sudden episodes over two days of dizziness followed by double vision, slurred speech and veering to the left; each episode lasted…
Clinical rotations · common