Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Episodes of Foul Smell and Bad Taste
Consult Page
25M transfer from outside hospital with brain mass. MRI pending.
Initial Imaging
None
Walking Thoughts
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What are the patient’s symptoms and presentation?
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What medical comorbidities does the patient have?
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What is the GCS of the patient?
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What workup has been completed so far?
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Where is the mass located and what are the important surrounding structures?
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Does the patient need surgery? Does he need emergent surgery or can this be deferred electively?
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Is the patient at risk for further seizures?
History of Present Illness
A 25 year old previously healthy male presented to an outside hospital with two days of severe nausea and lightheadedness. He also complained of several episodes of sudden-onset foul smell and bad taste, with each episode lasting for 60 seconds and self-resolving. He denied any associated loss of consciousness. Per report, a head CT at his local emergency department (ED) showed a well-circumscribed hypodense lesion in the posterior left frontal lobe without hemorrhage. He was started on levetiracetam and urgently transferred to our tertiary hospital ED.
Here in our ED, he has not had any additional episodes. On questioning, he reports that he has had mild headaches for a few months. The patient denies any vision changes, weakness, numbness, or speech deficits. He denies any use of antiplatelet or anticoagulant medication including aspirin-containing headache cocktails.
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