A 60-year-old man with expressive dysphasia.

A 60-year-old man (figure 1) was referred with an incidental abnormality in the right lower zone of his chest X-ray. He was otherwise well. Forty years previously a segment of his left lower lobe had been removed for a benign lesion. Two siblings had died from intracranial haemorrhage. High-resolution computed tomography (CT) scan of the thorax (figure 2) was performed. Before any treatment was given for the lesion visible in figure 2 he was admitted to hospital with right upper motor neurone facial weakness and expressive dysphasia of 2 days duration. CT scan of the head was carried out (figure 3).