We elected to admit her to the ICU unit and monitor her for 24 hours. ER TREATMENT: The patient's status was discussed with the attending physician. DIAGNOSIS: Cerebral contusion with basilar skull fracture. T1 pre contrast and post contrast scans are only required in case of tumor present in internal auditory canal. LABORATORY: Noncontrast CAT scan reveals pneumocranium on the left, with some edema of the left temporal lobe. Her abdomen is soft, nontender, without guarding, masses, or organomegaly. Breath sounds are bilaterally equal without rales, rhonchi, or wheezes. Herein, we present a case of the clinical and IAC MRI characteristic of RHS with multiple cranial involvements. Conversely, MRI of the internal auditory canal (IAC) was seldom applied, which was helpful in the diagnosis and differential diagnosis. No focal or lateralized deficits are demonstrable. In most cases, brain magnetic resonance image (MRI) shows no abnormalities. Deep tendon reflexes 2+ and equal bilaterally. Cranial nerves 2–12 are grossly intact as well. No distal neurologic deficit is noted on gross exam. She has blood and fluid coming out of her left ear. PHYSICAL EXAMINATION: This 16-year-old girl is in no acute distress, although she is intermittently somewhat confused and minimally combative. She was brought by ambulance here to the emergency department. She apparently was knocked out for 1 to 2 minutes, and after that awoke, being somewhat combative and confused. HISTORY OF PRESENT ILLNESS: This is an apparently 16-year-old female who was riding a horse today and was thrown, striking her head. FAMILY HISTORY: Negative for coronary artery disease, strokes, cancer, and diabetes.ĬHIEF COMPLAINT: Thrown from horse with loss of consciousness. The patient has been divorced for 3 years and currently lives by himself. The patient denies alcohol use and other illicit drug use as well. SOCIAL HISTORY: The patient has never been a smoker. CURRENT MEDICATIONS: The patient takes gemfibrozil 600 mg p.o. ALLERGIES: THE PATIENT HAS NO KNOWN MEDICAL ALLERGIES. Images through the head were taken both with and without. PAST SURGICAL HISTORY: The patient has had a sinus operation 15 years ago. BRAIN MRI WITH AND WITHOUT GADOLINIUM AND INTERNAL AUDITORY CANAL STUDY TRANSCRIBED SAMPLE. PAST MEDICAL HISTORY: The patient has hypercholesterolemia, as well as tinnitus. Patient also denies any change in stool caliber. The patient reports the hernia is also warm however, the patient denies any changes in bowel or bladder habits, any blood in the urine or stool, or any nausea or vomiting. The patient describes the pain as being constant but mild. The patient first noticed this problem last fall. HISTORY OF PRESENT ILLNESS: This established patient is a 59-year-old male who has a 3-month history of a tender left inguinal hernia. Physician completes a detailed review of systems, performs a comprehensive physical exam, and usually orders tests, x-rays, and lab work related to the patient’s condition or symptoms.
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