Consult Page 51F with 3d unremitting right facial pain Initial Imaging None Walking Thoughts ■ What are the characteristics and distribution of the facial pain? Is it shooting and electric-like? ■ Has the patient had any prior episodes of this pain? ■ Does she have any additional symptoms? ■ Does the patient have any imaging? ■ What treatments, if any, has the patient tried? ■ What…
Consult Page 5Y female presenting with eye movement abnormalities. MRI with Chiari malformation. Initial Imaging Walking Thoughts ■ What type of eye movement abnormality does she have? Does she have any other symptoms (e.g. headache, paresthesias, weakness)? ■ Does the patient have any signs or symptoms of hydrocephalus? ■ Does the patient have any signs or symptoms of brainstem compression? ■ Do these symptoms worsen with…
Consult Page 54F with wound breakdown at the abdominal site of her intrathecal baclofen pump Initial Imaging None Walking Thoughts ■ What are the patient’s vital signs? Is she hemodynamically stable? ■ What is the patient’s neurological exam? ■ Is there concern for sepsis and/or meningitis? Is she on antibiotics or should they be initiated? ■ Why does the patient have a baclofen pump? ■ Where…
Consult Page 18Y M presents with baclofen pump beeping Initial Imaging Walking Thoughts ■ What are the patient’s vital signs? ■ Is he hemodynamically stable? ■ What is the patient’s neurological exam? ■ Why does the patient have a baclofen pump? ■ How long has his pump been beeping? When was it last refilled or interrogated? ■ Has he had prior issues with his baclofen pump?…
Consult Page 48F here with abdominal pain, low grade fevers. CT abdomen shows multiple abscesses Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam and current vitals? ■ Does the patient have any neurological symptoms? Is she exhibiting any signs or symptoms concerning for sepsis or meningitis? What is the timeline of symptoms? ■ Why does the patient have a shunt? What is the…
Consult Page 57F here with fevers and history of falls and memory loss. Head CT shows hydrocephalus. Safety of LP? Initial Imaging Walking Thoughts ■ What is the patient’s current neurological exam? ■ What are the patient’s vitals? ■ Is there concern for acutely increased intracranial pressure or herniation? ■ What other symptoms does the patient have and what is the timeline? ■ Is the diagnosis…
Consult Page 14F with chronic sinusitis, prior meningitis pw headache, confusion, leakage from nose. Head CT unrevealing. Imaging recs? Initial Imaging Walking Thoughts ▪ What is the patient’s current neurological exam? ▪ What are her current vitals? ▪ What symptoms has she been having and what is the timeline? ▪ What is leaking from her nose? Is it clear? How long has she had this leakage?…
Consult Page 37F h/o pseudotumor with worsening vision, consult for shunt placement Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ What is the patient’s vision now and how quickly did it deteriorate? ■ Was the patient evaluated by ophthalmology for papilledema? ■ What other symptoms is she having? ■ What is the patient’s pseudotumor cerebri (PTC) history? How and when was she…
Consult Page 25 yo M hx VP shunt p/w lethargy and nausea. Recs? Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam and current vitals? ■ What are the patient’s symptoms? What is the timeline of symptoms? ■ Why does the patient have a shunt? ■ What type of shunt is currently in place? ■ What is the patient’s shunt history? ■ When was…
Consult Page 13yo M hx VP shunt with fall, now with emesis and lethargy Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam and current vitals? ■ What are the patient’s symptoms? What is the timeline of symptoms? ■ Why does the patient have a shunt? ■ What type of shunt is currently in place? ■ What is the patient’s shunt history? ■ When…
Consult Page 73F with NPH, unable to ambulate. Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? Why is she unable to ambulate? ■ Does she have any other medical comorbidities? ■ Is the patient having any other symptoms? ■ What is the timeline of her symptoms? ■ What is her normal pressure hydrocephalus (NPH) history? ■ Does the patient have a shunt? If…
Consult Page 7 y/o male with 2 weeks of fever and 1 day of acute midline forehead swelling Initial Imaging Walking Thoughts ■ What is the patient’s GCS and neurological status? ■ What are the patient’s vitals? ■ Does the patient have any risk factors for sinus infection? ■ Does the patient have any signs or symptoms of orbital involvement, intracranial involvement, meningitis, or encephalitis? ■…
Consult Page 13 y/o male, history of “brain cysts”, here with headache, nausea, vomiting Initial Imaging None obtained prior to consult Walking Thoughts ■ What is the patient’s GCS and neurological exam? ■ What is his prior history of “brain cysts”? ■ Does the patient have any signs or symptoms of increased intracranial pressure (ICP) or mass effect from the cyst? ■ Where in the brain…
Consult Page 9 year old male history of tethered cord with worsening leg weakness/pain Initial Imaging Walking Thoughts ■ What is the patient’s medical history? What is his tethered cord history? ■ Has he had prior detethering or related surgeries? ■ What are the patient’s symptoms (weakness, pain, bowel/bladder dysfunction)? ■ How long has the patient been having symptoms? ■ What type of imaging is available?…
Consult Page Young male football accident. Heard a pop in neck. Now with decreased strength/sensation on right side. Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ What was the mechanism of injury? ■ Does the patient have any other injuries? Has a trauma assessment been completed? ■ Is he wearing a cervical collar? ■ What imaging has been completed? You’re Reading a…
Consult Page 2 month old with right sided jerking and decreased appetite Initial Imaging Walking Thoughts ■ Has the trauma team performed an initial assessment with attention given to the ABCs (airway, breathing, circulation)? ■ What is the mechanism of injury? ■ What is the child’s GCS and neurological status? ■ Is there concern for elevated intracranial pressure? ■ What is this child’s past medical history?…
Consult Page 11 yo healthy F, fall from bike with skull fracture Initial Imaging Walking Thoughts ■ What is the patient’s GCS and neurological status? ■ What is the mechanism of injury? ■ Does the patient have any other injuries? Has the patient been evaluated by the trauma team? ■ What was the patient’s condition immediately after the injury? ■ How large is the fracture? Is…
Consult Page 4 y/o male with depressed skull fracture and head laceration after fall from bed this morning Initial Imaging Walking Thoughts ■ What is the patient’s GCS and neurological status? ■ What is the mechanism of injury? ■ Does the patient have any other injuries? Has the patient been evaluated by the trauma team? ■ What was the patient’s condition immediately after the injury? ■…
Consult Page 4mo boy p/w BLE weakness and large mediastinal mass Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? How weak is the patient? Does he have any other symptoms of sensation, bowel, or bladder dysfunction? ■ What is the timeline of his deficits? ■ What is his prior medical history including any congenital or developmental problems? ■ Does he have any other…
Consult Page 7 year old girl with headaches, vomiting, and abnormal brain MRI Initial Imaging Walking Thoughts ■ How long has she been having symptoms? ■ What is her neurological exam? ■ Is she having any vision changes or cranial nerve deficits? ■ Does this patient need emergent surgery for management of herniation or hydrocephalus? ■ Will this require resection or biopsy only? You’re Reading a…