Reference no: EM133815931

Question 

The patient is a 39 year old male who was found lying on the sidewalk outside a bar. There was a 2-cm laceration on the occipital lobe. Upon arrival in the ED, he appeared intoxicated. His speech was slurred, but he followed simple commands appropriately. There were no focal neurologic deficits. Glasgow Coma Scale was 13 total in the ED. The scalp laceration was cleaned and sutured. He was given intravenous hydration 500 mL and thiamine 100 mg tid, and was observed for 4 hours in the ED. During this time, his mental status gradually improved. His blood tests were unremarkable aside from an ethanol level of 295 mg/dL (a blood alcohol level of 0.295). Because of the patient's age, history of alcoholism, and evident head trauma, a head CT was performed. Radiologist's report identifies the left Sylvian fissure and adjacent cortical sulci are slightly enlarged compared to the right. This was due to mild loss of brain tissue of the left cerebral hemisphere (encephalomalacia), which was likely the result of old trauma or cerebrovascular disease. DX: Subdural hematoma. Neurosurgeon, Dr. Wanani, was brought in to determine if surgical evacuation of the hematoma was recommended. Dr. Wanani recommended monitoring the.