MRCP2-3281

MRCP2-3281

A 67-year-old man presents to the Emergency department with confusion. His wife reports that he has been acting strangely for the past two days, experiencing difficulty with his clothing and making unusual swallowing movements. He has also had several episodes of twitching in his right hand and speech impairment. The patient has a medical history of type II diabetes, hypertension, and partial epilepsy. He takes metformin, bendroflumethiazide, phenytoin, and carbamazepine regularly. He is a smoker and drinks alcohol occasionally. On examination, he appears confused with a Glasgow coma scale of 13/15. His blood pressure is elevated, and he has subtle nystagmus and increased tone in his right upper limb. Chest and cardiovascular examination reveal left basal crackles. Investigations show multiple periventricular ischaemic white matter changes on a CT scan of the brain. How would you manage this patient?