A 74-Year-Old Man with Metastatic Lung Cancer Is Brought to the Emergency

A 74-year-old man with metastatic lung cancer is brought to the emergency department due to sudden-onset severe headache, nausea, and vomiting.  The patient was diagnosed with squamous cell lung cancer 4 months ago and was found to have metastasis to the right frontal lobe of the brain.  He refused chemotherapy and radiation treatments and is receiving palliative care.  Blood pressure is 142/86 mm Hg, pulse is 100/min, and respirations are 20/min.  On examination, the patient is somnolent but wakes up to voice and follows instructions.  Urgent CT scan of the head reveals hemorrhage within the tumor, causing significant surrounding edema; the right cingulate gyrus is seen herniating beneath the falx cerebri.  Which of the following findings is most likely to be present in this patient given his neuroimaging results?

A) Dilated and fixed right pupil
B) Left lower extremity weakness
C) Leftward conjugate eye deviation
D) Loss of gag and cough reflexes
E) Nonfluent/agrammatic speech

Correct Answer:

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