Question 3

Questions 1-3 Refer to the Following Case:

A 45-year-old former bank executive presents to a neurologist after being discharged from a subacute inpatient facility 6 months after he received a severe closed head injury in a motor vehicle accident. He is able to ambulate independently but continues to have residual difficulties with functional use of his right hand, distractibility, disorganization, and poor longterm memory as well as irritability and anger outbursts. The patient’s anger outbursts are occasionally violent and can seem unprovoked, but they tend to be triggered by episodes where others point out information that he was told but cannot remember.


The patient improves and makes an attempt to return to working after 1 year. The patient performs relatively well with a limited work schedule and activities tailored to his current abilities, although he is no longer managing in an executive role. However, 2 months into work the patient seems to be declining rather than improving, with his performance worsening over the course of several weeks. Colleagues describe him as slowing down, showing poor concentration, and not keeping up with his limited list of tasks. As part of the evaluation, the neurologist orders a routine complete blood count and chemistries, a computed tomography scan, and electroencephalography. Which of the following potential causes of decline would require additional evaluation?