Man with headache and altered mental status

xlomafota13 shared this article with you from Inoreader Man with headache and altered mental status Via leak of cerebrospinal fluid Emerg Med J. 2021 Jul;38(7):519-528. doi: 10.1136/emermed-2020-210071. ABSTRACT PresentationAn 83-year-old man presented for headache and altered mental status. Four days prior, he underwent endoscopic sinus surgery for nasal polyps. Over the two previous days, he gradually developed a headache and was brought to the emergency department when his wife noted mild confusion and generalised weakness. His examination was notable for a heart rate of 101 beats per minute, clear nasal discharge, meningismus and confusion to the date with generalised weakness. A lumbar puncture revealed cloudy cerebrospinal fluid (CSF) with a white blood cell count of 3519x10ˆ9/L (95% neutrophils). A CT scan of the head was obtained (figure 1).emermed;38/7/519/F1F1F1Figure 1Non-contrast CT scan of the head in axial plane. QUESTION: What is the appropriate next step in management?Obtain MRI of the brain to localise ischaemic damage.Administer broad-spectrum antibioti cs, including pseudomonal coverage.Consult otolaryngology to arrange functional endoscopic sinus surgery for CSF leak closure.Consult neurosurgery for surgical decompression of mass lesion(s). PMID:34449420 | DOI:10.1136/emermed-2020-210071 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.