An urgent care nurse practitioner comes in to examine his patient, a 77-year-old woman who was brought in by her family for altered mental status. He notes that the patient appears restless and does not know where she is. Upon further assessment, he notes that her pupils are sluggish to react to light and are unequal in size. She is unable to sit up at the side of the bed and her blood pressure is 190/88 mm Hg. Which of the following does the NP suspect?