More steroids or less? That is the question!

A 45-year-old man who immigrated to Canada from Ghana at the age of 33 presented with a 2-year history of progressive cognitive changes. He had bifrontal headache, right-sided scalp paresthesias, and a 40-pound weight loss. He was unable to perform his job as an auto parts worker. His wife noticed shortand long-term memory problems and poor concentration. On physical exam he had no focal neurological findings but his score on the Mini-Mental Status Exam (MMSE) was 23/30, with deficits in attention and recall.