Falls, Memory Loss, And Fevers

Consult Page

57F here with fevers and history of falls and memory loss. Head CT shows hydrocephalus. Safety of LP?

Initial Imaging

Walking Thoughts

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  What is the patient’s current neurological exam?

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  What are the patient’s vitals?

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  Is there concern for acutely increased intracranial pressure or herniation?

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  What other symptoms does the patient have and what is the timeline?

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  Is the diagnosis of hydrocephalus known or new?

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  What type of hydrocephalus does the patient have (e.g. communicating, obstructive)?

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  Is there concern for infection? If so, what bloodwork has been sent?

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  Why is a lumbar puncture being considered?

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  What additional imaging does the patient need?

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  Is the patient on any antiplatelet or anticoagulant medication?

History of Present Illness

A 57 year old female with a history of a renal transplant and rheumatoid arthritis presents to the emergency department (ED) with fevers and abdominal pain. Her symptoms began a few days ago with intermittent fevers, chills, abdominal pain, decreased appetite, and fatigue. She has also had about a year of headaches, memory difficulties, and imbalance. Currently, she has a headache that feels like her usual headaches, but denies any nausea, vomiting, photophobia, phonophobia, focal weakness, numbness, tingling, or vision changes. She is on long-term immunosuppressive medications for her renal transplant but is not on any anticoagulant or antiplatelet medications.