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CASE
A 38 year-old male, originally from Saudi Arabia, is admitted with unsteadiness, diplopia and dysarthria that started 5 days ago and has progressed. He is difficult to rouse. On examination, his GCS is 11. Temperature is 37.8 °C, blood pressure is 133/88 mmHg, heart rate is 78 bpm and respiratory rate is 12/min. He has dysarthria, ataxia, a complex ophthalmoplegia, and mild pyramidal weakness in all four limbs. MRI of the brain is shown below. CRP is 14 mg/dl. CSF analysis shows 88 white cells per mm3, protein level of 0.78g/l and glucose level of 4.4 mmol/L. Blood glucose is 6.7 mmol/L. What is the most likely diagnosis?

A. Behcet's disease
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B. Listeria rhombencephalitis
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C. Sarcoidosis
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D. Tuberculosis
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E. Wilson's disease
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