You are asked to evaluate a 46-year old man because of worsening somnolence 1 day after he underwent proximal femoral replacement surgery for chondrosarcoma involving the left femur. He had developed a pathological fracture of the femur after a fall 5 weeks earlier (see radiograph below). Surgery was complicated by a crack in the femur during implantation of the prosthesis. The surgical specimen and histology are shown below. Pertinent findings on your exam included the following: 1. tachycardia & tachypnea; 2. somnolence (responds to voice & pain, but no spontaneous movement or communication); 3. mild nuchal rigidity and a positive Kernig's sign.
What is your diagnosis and what test(s) would you order to confirm your suspicions?
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