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Altered Mental Status With Brain Lesions


Consult Page

53F, history of IVDU, found unresponsive, HCT with multiple brain lesions, large vents.

Initial Imaging

Figure 16.1, An axial head CT without contrast shows a hemorrhagic 3 cm right parieto-occipital lesion with enlarged lateral ventricles (A) and a left 3.5 cm cerebellar hypodensity with surrounding edema and mild compression of the fourth ventricle (B).

Walking Thoughts

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    What is the patient’s current Glasgow Coma Scale (GCS) score? Is the patient protecting her airway?

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    What is the cause of her unresponsiveness (e.g. a drug effect, a seizure, or acute hydrocephalus with brainstem compression)?

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    What is the etiology of her brain lesions and what workup will she need?

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    Does she need an emergent external ventricular drain (EVD) placed? Does she need to go to the operating room emergently?

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    Is the patient on any anticoagulant or antiplatelet therapy?

History of Present Illness

A 53 year old female with a history of hypertension, intravenous drug use (IVDU), smoking, alcohol abuse with prior hospitalizations for withdrawal, and bipolar disorder presents with altered mental status. Earlier that day, she was witnessed to be walking oddly and then collapsed to the floor with full body shaking and left gaze deviation. A bystander called emergency medical services, who transported the patient to the emergency department (ED). There are no family or friends to give additional history.

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