ABSTRACT
A 42-year-old man presents to the accident and emergency department after a grand mal seizure having had a headache and feeling unwell for several weeks. He is a little confused and has a slight weakness with brisk reflexes in the right arm and leg. He has an extensor plantar response in his right foot. He has a subtle facial weakness on his right side affecting predominantly the
lower part of his face. His wife has noticed he has had trouble sometimes understanding what she is saying in the last few weeks.
