A 37-year-old man with daily morning headaches and a new unilateral hand weakness over two months most likely has which diagnosis?

• A. Focal seizure disorder
• B. Intracerebral neoplasm
• C. Transient ischemic attack
• D. Amyotrophic lateral sclerosis

Answer: (B)

A space-occupying brain lesion causing raised intracranial pressure with a new focal motor deficit best fits this presentation. Morning headaches occur when intracranial pressure is elevated, often from a mass that irritates the meninges and disrupts CSF dynamics. A new unilateral hand weakness developing over a couple of months localizes to the contralateral motor cortex or its pathways, which is exactly what a brain tumor in a cortical or subcortical region can produce.

Seizure disorders typically present with episodic events or transient postictal weakness rather than a steadily progressive focal deficit over months. TIAs cause brief neurologic symptoms that resolve, not a persistent weakness. ALS can cause progressive weakness, but headaches are not a feature and the pattern here fits a lesion with mass effect more than a degenerative motor neuron disease. Imaging would be needed to confirm a brain tumor as the source.