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Dorchester Center, MA 02124

Newborn With a Lumbar Spinal Defect

Consult Page Newborn male with lumbar spinal defect Initial Imaging Wallking Thoughts ■ What is the mother’s pregnancy history? ■ What is the patient’s birth history and comorbidities? ■ What is the patient’s current clinical status (vitals, oxygenation, apneic or bradycardic events)? ■ Is this open spina bifida (myelomeningocele) or closed spina bifida? ■ What does the defect look like (size, presence of a membrane, presence…

Prematurity And Abnormal Head Imaging

Consult Page 3 day old premature twin with intraventricular hemorrhage Initial Imaging Walking Thoughts ■ What is the mother’s pregnancy history? ■ What is the patient’s birth history and comorbidities? ■ What is the patient’s current clinical status (vitals, oxygenation, apneic, or bradycardic events)? ■ What type of imaging was completed? ■ What is the extent of the hemorrhage? ■ Is there any ventriculomegaly or hydrocephalus…

Worsening Back And Leg Pain

Consult Page 45F hx HIV, IVDU, MRI w/ osteodiscitis p/w intractable back and leg pain Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? Does she have any red flag symptoms (e.g. cauda equina syndrome)? ■ Is the patient hemodynamically stable? ■ Are her inflammatory markers elevated? ■ What is the timeline for the patient’s symptoms? ■ What is the baseline function of the…

Right Leg Numbness And Foot Drop

Consult Page 36M skateboarding accident, can’t feel or move below right knee Initial Imaging Walking Thoughts ■ What was the mechanism of the trauma? ■ Are there any fractures (e.g. fibular head/neck)? Are there other associated vascular (e.g. popliteal artery), meniscal, or ligamentous injuries? ■ Are the neurological findings consistent with injury to a particular nerve? If so, what is the mechanism of nerve injury (e.g.…

Sudden Bilateral Lower Extremity Weakness With Hemodynamic Instability

Consult Page 60M h/o metastatic prostate cancer presenting with leg weakness, MRI with abnormal T2 signal and enhancement, thoracic compression fracture Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ What is the onset and progression of the patient’s weakness (acute versus chronic)? Is the patient having any other symptoms (e.g. numbness, bowel/bladder dysfunction, saddle anesthesia)? ■ What is the patient’s prostate cancer…

Subacute Leg Pain, Numbness, And Weakness

Consult Page 61F with bilateral lower extremity pain and weakness, MRI showing possible fistula Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ Is the patient weak, or is her weakness pain limited? ■ What is the timeline of her symptoms? ■ Where is the fistula on MRI? Do the patient’s symptoms localize to the site of the lesion seen on MRI? ■…

Acute Inability To Walk

Consult Page 45M patient with hx metastatic colorectal cancer with inability to walk Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam—what are his deficits? ■ Why is the patient unable to walk? Is it secondary to pain or to weakness? ■ Does he have any bowel or bladder dysfunction? ■ How long has he had symptoms? ■ What is the patient’s oncologic history?…

Worsening Back Pain And Leg Weakness

Consult Page 73M PMH diastolic heart failure, here with back pain, LE weakness, and recurrent falls Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ What other symptoms is he having? Are there any red-flag symptoms or concern for cauda equina syndrome? ■ What is the timeline of his symptoms (e.g. acute, chronic, progressive)? ■ Do his symptoms correlate with the imaging findings?…

Arm And Leg Weakness And Numbness After MVC

Consult Page 55M hx of C4-6 fusion presenting with loss of sensation and weakness in right arm after MVC Initial Imaging Walking Thoughts ■ What are the patient’s current ABCs? Has the trauma team evaluated him yet? ■ What is the severity of the patient’s motor and sensation deficits? Is he weak in the right arm only or also in other extremities? ■ What is the…

Right Leg Pain And Weakness With Prior Lumbar Fusion

Consult Page 73M with history of prior lumbar surgery with right leg pain and thigh weakness. MRI shows synovial cyst. Please evaluate. Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ What other symptoms does the patient have (e.g. mechanical back pain, bowel or bladder symptoms, saddle anesthesia)? ■ How long have the symptoms been bothering him? ■ What was the patient’s prior…

Leg Pain, Weakness, And Saddle Anesthesia

Consult Page 31F pregnant with leg weakness and pain. MRI with severe compression. Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ What symptoms does the patient have? What is the timeline of her symptoms? ■ Does the patient have any history of recent trauma? ■ Is there concern for cauda equina syndrome? ■ What is the patient’s postvoid residual or bladder scan?…

Leg Weakness And Numbness

Consult Page 47M with leg weakness, and sensory level Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam—how weak are his legs? Where is his sensory level? ■ How long has he had symptoms? ■ What is the patient’s medical history? Is there any trauma or oncologic history? ■ Does he have any bowel or bladder dysfunction? ■ Does he need surgical intervention urgently…

Left Neck And Shoulder Pain

Consult Page 54M with prior shoulder surgery now with L neck/shoulder pain and numbness. MRI with disc herniation. Please evaluate. Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ Are the symptoms limited to pain and numbness or are there any signs of weakness or myelopathy? ■ Is the patient’s prior shoulder surgery related to his symptoms? ■ Why did the patient choose…

Neck Pain And Left Arm Weakness

Consult Page 50M p/w worsening neck pain and new LUE weakness, cord compression on MRI Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? Are there any long tract findings? ■ What is the timeline of the patient’s symptoms? ■ What other symptoms does the patient have? Does he have any gait instability, or bowel and bladder symptoms? ■ Does the pain radiate into…

Lower Back And Right Leg Pain

Consult Page 72F w L4-5 stenosis with worsening lower back and leg pain Initial Imaging Walking Thoughts ■ Where is the patient’s back and leg pain? ■ What is the patient’s neurological exam? ■ Is there any concern for cauda equina syndrome (e.g. saddle anesthesia, leg weakness, incontinence)? ■ What is the timeline of these symptoms? How stable or progressive have they been, and how do…

Acute Loss of Consciousness

Consult Page 35F found down, head CT with bleed, bradycardic now Initial Imaging Walking Thoughts ■ What is the patient’s GCS? How is her airway, breathing, and circulation? ■ When was the patient last seen normal? How long was she down for? ■ Does the patient have any coagulopathies? ■ There is significant mass effect on the head CT. Has the emergency department (ED) maximized medical…

Acute Onset Left Hemiparesis

Consult Page 72M presents with L sided weakness, stroke team activated, R ICA stenosis. Initial Imaging Walking Thoughts ■ Have the patient’s ABCs been addressed? ■ What is the patient’s neurological exam? When was the patient last seen normal? ■ Does the patient have an acute stroke? Has neurology evaluated the patient? ■ What is the cause of stroke? Does the patient have internal carotid artery…

Right Eye Swelling And Pain

Consult Page 81M here with right eye swelling and pain, CT angiogram possible carotid-cavernous fistula Initial Imaging Walking Thoughts ■ Is the onset of symptoms sudden or gradual? Is there antecedent trauma? ■ Does the patient take any anticoagulant or antiplatelet medications? ■ Has ophthalmology been consulted to evaluate the eye? ■ Is the fistula a direct or indirect fistula? ■ Does the fistula warrant urgent…

Seizure

Consult Page 40M with cerebral palsy presents with a seizure, MRI possible cavernoma. Initial Imaging Walking Thoughts ■ Have the ABCs of airway, breathing, and circulation been assessed? ■ What is the current GCS of the patient? ■ What is the semiology of the seizure? ■ Are there any post-ictal neurological deficits? ■ What is the patient’s baseline neurological function given his cerebral palsy? ■ Is…

Persistent Altered Mental Status

Consult Page 60M with AMS and sepsis with SAH found on MRI to have possible vascular lesion. Consulting for further recs. Initial Imaging Walking Thoughts ■ What has been the patient’s hospital course so far? What other comorbidities does the patient have? ■ What other etiologies could be contributing to the patient’s altered mental status? What work-up has been performed for this? ■ What is the…