Headache and Focal Weakness

🗒️ Question

A 64 year old man presents with progressive headaches, nausea and occasional vomiting over the past four weeks. He has also noticed increasing confusion and memory problems. His wife reports that he has had a few episodes of stumbling and weakness in his right leg.

On examination, he is alert but slightly disoriented to time. His GCS is 14/15. Power in his right leg is reduced to 4/5 and he has an up-going plantar reflex on the right.

Investigations:

• Haemoglobin: 13.2 g/dL (130–180)

• White cell count: 8.4 × 10⁹/L (4.0–11.0)

• Platelets: 250 × 10⁹/L (150–400)

What is the investigation of choice for confirming the diagnosis?

(A) CT head

(B) CT head with contrast

(C) MRI brain with contrast

(D) Lumbar puncture

(E) EEG