Case 133

Medical history

A 65-year-old male patient, hospitalized after sudden episode of vertigo, nausea and dysarthria, with rapid evolution to hemiplegia and a decreased level of consciousness in 24 hours. At physical examination, the patient was afebrile with complete bilateral horizontal gaze palsy and dysdiadochokinesia. His medical history shows a longtime smoker and a poorly controlled high blood pressure. To the initial evaluation was request cranial computerized tomography (CT) scan, lumbar puncture and electroencephalogram (EEG).

Based on clinical history and on examination of the test results, the most likely diagnosis is:

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