A 35 year old woman is brought to the ED by ambulance for confusion and syncope. Medics report that she was seen earlier that day in the ED and diagnosed with a URI. The patient is quite bizarre and is triaged in as a psych patient. She is oriented to name only. When asked if she is in pain she answers “20 minutes”. When asked again she speaks gibberish and is repetitive, answering “faculate”. She answers “yes” to all yes or no type questions including those that are obviously incorrect. To open ended questions she answers with more gibberish often using the words “faculate” and “brakelight”. On exam, she is purposeful, her vital signs and are normal and her exam is non-focal, but limited in that she follows only simple commands. Lab tests are normal except for 25 WBC’s in her urine a WBC count of 14, a serum glucose of 215 and a tox screen which is positive for opiates. CT of the brain is normal. A diagnostic procedure is performed with results shown below. What is the diagnosis?

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