MRCP2-2348

MRCP2-2348

A 32-year-old man presented to the Emergency Department with a 12 h history of a severe headache, left-sided hemiparesis and new-onset tonic-clonic seizures. He denied taking any medication or illicit drugs.
He had a temperature of 37.2 °C, pulse 110 bpm, sinus rhythm and a blood pressure of 120/80 mmHg.
Investigations:
s
Haemoglobin (Hb) 140 g/l 135 – 175 g/l
White cell count (WCC) 8.0 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 200 × 109/l 150 – 400 × 109/l
International normalized ratio (INR) 1.2 < 1.1
Activated partial thromboplastin clotting time (APTT) 30 s 25 – 35 s
Creatinine (Cr) 100 µmol/l 50 – 120 µmol/l
Urea 5.0 mmol/l 2.5 – 6.5 mmol/l
Bilirubin 20 μmol/l 1 – 22 μmol/l
Aspartate aminotransferase (AST) 30 u/l 10 – 40 u/l
Alanine aminotransferase (ALT 40 u/l 7 – 55 u/l
Lactate dehydrogenase (LDH) 400 u/l 140 – 280 u/l

What is the most likely underlying diagnosis?