Viva 5

A 54-year-old man with type 2 diabetes mellitus and psoriatic arthritis on monoclonal antibody therapy presents with a two week history of progressive headache, nausea and vomiting, fever and an unsteady gait. He has had a recent episode of sinusitis which was treated with oral antibiotics.

He has returned one week previously from a camping trip to North America and transited via Hong Kong for two days on his return to Australia. He was born in Taiwan and visits regularly.

On examination he is febrile to 38° celsius. He is stable from a cardiorespiratory point of view. His Glasgow Coma score is 15 with some slowness in answering questions. There is no neck stiffness. No cranial nerve abnormalities or other neurological deficits are noted.

CT (non-contrast) of his Brain is normal apart from frontal sinusitis.

What is your differential diagnosis for this man’s presentation?

This is a returned 

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.