50 year-old male with new onset of left hemiparesis

by Claudiu Matei, MD PhD (1) and Victoria Bîrluțiu, MD PhD (2)

1 = Polisano European Hospital, 'Lucian Blaga' University, Sibiu, Romania
2 = Sibiu County Emergency Hospital, 'Lucian Blaga' University, Sibiu, Romania
A 50 year-old male presented with new onset of left hemiparesis for the past 2 days. The patient was referred to ER of a primary hospital. An urgent cranial CT scan of the head was performed, which revealed right fronto-parietal abnormalities. The patient was transferred to our Hospital. Upon neurological examination the patient appeared conscious, fully orientated, presenting with a mild headache, left hemiparesis (3/5 grade), with standing and walking difficulties. The patient lives in the countryside and works on a farm. His past medical history revealed a non-small cell lung carcinoma with controlled local disease.

Figure 1a. CT scan, native examination, axial cut, reveals a fronto-parietal hypodensity

Figure 1a. CT scan, native examination, axial cut, reveals a fronto-parietal hypodensity

Figure 1b. CT scan, postcontrast exposure, sagittal view, shows two right fronto-parietal “ring enhancement” lesions

<strong>Figure 1b. </strong>CT scan, postcontrast exposure, sagittal view, shows two right fronto-parietal “ring enhancement” lesions

* 1. Based on these images (1a and 1b) and according to the history of the patient and the clinical status, what other test would you like to have?

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