Quiz 16 Context:
An 80 year-old-female presents with the new onset of seizure activity. She was living independently until recently, when she began staying with family members after they had noticed she was having difficulty caring for herself. Earlier that day she had a witnessed tonic-clonic seizure.
The patient's family states the patient had been previously well until approximately 3 months ago when she began to complain of moderate to severe headaches which were unresponsive to over-the-counter pain relievers. This was followed by the subtle, gradual development of memory loss, personality changes, and eventually confusion. Her past medical history is significant for osteoarthritis and benign hypertension. She denied any drug or alcohol use.
Physical examination reveals a thin female in no acute distress, but who appears apathetic and indifferent. Vital signs are normal. Fundoscopy suggests papilledema. Neurologic examination demonstrates left sided hemiparesis with associated hyper-reflexia. Mental status examination reveals cognitive impairments.
An MRI with gadolinium is performed; a coronal T1-weighted image is shown above.
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This finding is most consistent with which of the following?
- Normal pressure hydrocephalus
- Hemorrhagic stroke
- Glioblastoma multiforme
- Multiple sclerosis with unidentified bright objects