Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Headaches And Vomiting

Consult Page 8F presents with headache, vomiting. CT shows intraparenchymal hemorrhage. Initial Imaging Walking Thoughts ■ Have the ABCs of airway, breathing, and circulation been addressed? ■ What is the patient’s current GCS? ■ Was there any witnessed trauma or evidence that this might be a traumatic injury? ■ Does the patient have any comorbidities that would predispose her to stroke, vascular malformations, malignancy, or clotting…

Worst Headache Of Life

Consult Page 65F with worst headache of life, nausea, vomiting, confusion. CT + subarachnoid hemorrhage Initial Imaging Walking Thoughts ■ What is the current GCS of the patient? Is she able to protect her airway? ■ Is the patient on any anticoagulant or antiplatelet medications? If so, have reversal agents been given? ■ Are coagulation labs available or pending? ■ What medical comorbidities does the patient…

Headache

Consult Page 58F with PMH of lung cancer presents with headaches, MRI new met to brain and a right ICA aneurysm. Initial Imaging Walking Thoughts ■ How bad is the headache? Is it the worst headache of her life? ■ Does she have other symptoms? ■ What is the timeline of her symptoms? ■ What is the patient’s neurological exam? Is there concern for aneurysm rupture?…

Acute Aphasia And Right-Sided Weakness

Consult Page 89F with a left MCA syndrome and perfusion mismatch, consult for thrombectomy Initial Imaging Walking Thoughts ■ Have the ABC’s been appropriately addressed? ■ When was the patient last seen normal? ■ Has the stroke team evaluated the patient? ■ Was tissue plasminogen activator (tPA) given? ■ What is the patient’s NIH stroke scale score? ■ Is the patient on any antiplatelet or anticoagulant…

Patient Found Down

Consult Page Patient with large stroke and swelling causing midline shift Initial Imaging Walking Thoughts ■ What are the patient’s ABCs? ■ What are the patient’s medical comorbidities? ■ What is the patient’s baseline function, and what is his current neurological exam? ■ Has stroke neurology team been consulted? ■ When was the patient last seen normal? ■ Is there any viable brain tissue/penumbra? ■ Is…

Altered Mental Status

Consult Page 55M presenting with AMS and head CT with large left sided subdural hematoma Initial Imaging Walking Thoughts ■ What is the timeline of the patient’s symptoms? ■ What is his current GCS? ■ Is there a history of recent trauma or falls? ■ Is he intubated? If so, is there any paralytic that may affect the clinical exam? ■ What are the patient’s medical…

Severe Headache

Consult Page 57 year old female with large cerebellar hemorrhage Initial Imaging Walking Thoughts ■ What is the mechanism of the bleed? ■ What is the patient’s GCS? Does the patient need airway protection? ■ Was the exam performed on sedation? ■ Are there signs of intracranial pressure (ICP) elevation or herniation? If so, have medical measures been initiated? ■ Is there intraventricular hemorrhage (IVH) or…

Unresponsive Patient

Consult Page 70yo male found down with a large brain bleed. Initial Imaging Walking Thoughts ■ Where is the hemorrhage? ■ What is the mechanism of the bleed? ■ What is the patient’s GCS? Does the patient need airway protection? ■ Was the exam performed on sedation? ■ Are there signs of intracranial pressure (ICP) elevation or herniation? If so, have medical measures been initiated? ■…

Progressive Neurocognitive Decline

Consult Page 27F bilateral jaw dislocation. CT with large bifrontal lesion Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ What other symptoms does the patient have? ■ What is the timeline of her symptoms? ■ Does the patient have any comorbidities? ■ Is there any personal or family history of cancer, infection, or autoimmune disease? ■ Did the patient have a seizure…

Headache, Blurry Vision, And Intraventricular Mass

Consult Page 20F with headache and dizziness with hydro on OSH CT. MRI pending. Initial Imaging Pending Walking Thoughts ■ What is the patient’s neurological exam? Does she have decreased mental status that requires an emergent intervention (e.g. external ventricular drain)? ■ What other symptoms is she having? How long has the patient had symptoms? Have the symptoms changed recently? ■ Is the outside hospital imaging…

Sudden Headache And Vision Loss

Consult Page 45M, Headache, vomiting, sudden vision loss and suprasellar mass Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? ■ What are the patient’s vitals? ■ Does the patient have a known pituitary adenoma or suprasellar mass? ■ Are his symptoms related to the suprasellar mass or is the suprasellar mass an incidental finding (e.g. rule out stroke, elevated intracranial pressure)? ■ Is…

Incidental Sellar Mass After An Accident

Consult Page 23F Headache after MVC. MRI with sellar mass Initial Imaging Walking Thoughts ■ What are the patient’s vitals? ■ What is her neurological exam? ■ Does she have any other injuries from the motor vehicle accident? ■ Is the sellar mass a known diagnosis or is it new? ■ Does she have any vision loss? ■ Are her current symptoms related to the sellar…

Altered Mental Status With Brain Lesions

Consult Page 53F, history of IVDU, found unresponsive, HCT with multiple brain lesions, large vents. Initial Imaging Walking Thoughts ■ What is the patient’s current Glasgow Coma Scale (GCS) score? Is the patient protecting her airway? ■ What is the cause of her unresponsiveness (e.g. a drug effect, a seizure, or acute hydrocephalus with brainstem compression)? ■ What is the etiology of her brain lesions and…

New Onset Seizure With Prior History Of Melanoma

Consult Page 64M with history of melanoma presents with a seizure. Head CT concerning for mass/swelling Initial Imaging Walking Thoughts ■ What is the patient’s current neurological exam and mental status? ■ What is the semiology of his seizure? Is he still seizing? ■ What is his melanoma history? Does he have any prior metastasis? ■ What is his baseline level of independence and function? What…

Headache And Right Arm Weakness

Consult Page 70M new mass on CT Initial Imaging Walking Thoughts ■ What is the patient’s neurological exam? Does he have decreased mental status or any associated neurological deficits? ■ How long has the patient had symptoms, and have the symptoms changed recently? ■ Has the patient had any seizures? ■ Does the patient have a history of other malignancies? ■ Does the patient need surgical…

Episodes of Foul Smell and Bad Taste

Consult Page 25M transfer from outside hospital with brain mass. MRI pending. Initial Imaging None Walking Thoughts ■ What are the patient’s symptoms and presentation? ■ What medical comorbidities does the patient have? ■ What is the GCS of the patient? ■ What workup has been completed so far? ■ Where is the mass located and what are the important surrounding structures? ■ Does the patient…

Headache, Nausea, And Speech Difficulty

Consult Page 51 F p/w headache, nausea, and speech difficulty, MRI large mass. Initial Imaging Walking Thoughts ■ What is the patient’s mental status and neurological exam? ■ Are the neurological findings due to the mass effect or are they seizures? ■ How long has she been having symptoms? ■ Is she actively seizing? ■ Has she received anti-seizure medication? Will this affect the neurological exam?…

Vomiting And Neck Pain After Motor Vehicle Accident

Consult Page 20M, MVC, here w/ confusion, vomiting and neck pain Initial Imaging None Walking Thoughts ■ Have the ABCs been assessed? ■ Has the patient been examined by the trauma team? ■ What imaging is available? ■ Is there an intracranial bleed causing his symptoms? ■ Is the patient wearing a hard cervical collar? History of Present Illness A 20 year old male is brought…

Back Pain After Low-Impact Trauma

Consult Page 57F sp fall, CT T12 burst fracture. Initial Imaging Walking Thoughts ■ What was the mechanism of injury? ■ Does the patient have any neurological deficits? ■ What kind of pain does the patient have? ■ What is the baseline function and ambulatory status of the patient? ■ Has the trauma team evaluated the patient? ■ Is there concern for concomitant cervical or lumbar…

Left Arm And Neck Pain After Car Accident

Consult Page 73yF passenger in an MVC p/w neck and LUE pain. L C6-7 perched facet on CT. Initial Imaging Walking Thoughts ■ What was the mechanism of the accident? Was the patient wearing a seat belt? ■ Has the patient been evaluated by the trauma team? ■ What other injuries does she have, and which is the most critical? ■ Any concern for intracranial injury?…