In addition to the suggestions so far regarding investigation and
treatment, I'll add the following specific points. First, doubly
incontinent is suggestive of intracranial pathology until proven
otherwise. Second, being 5 week postpartum, I'll keep in mind dural
sinus thrombosis as the primary problem + ?secondary head injury
following ?seizure ?fall. Dural sinus thrombosis is a rare complication
of pregnancy and the puerperium. Can present as late as 3 months
postpartum.
Abel Wakai
Dublin
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Scott, Charles
Sent: 02 March 2004 10:59
To: [log in to unmask]
Subject: Case presentation - acute confusion
24 year old local woman brought to Emergency Unit by husband who had
come
home from work in the afternoon to find her lying on the floor confused
and
very restless. Been doubly incontinent . Last seen by husband that
morning as she left the house to take children to school. Has 5 week
old
baby, normal delivery.
No known other medical Hx, no known drug or alcohol abuse.
O/E
Restless++
Not talking, moaning. Fights off any touch. Bruises (?24+ hrs old) on
both upper arms and sides of head and ear lobes. Not petechial. No
neck
stiffness.
Pulse 125, BP 119/70, resps 24, Temp 37.0; Cap refill <2 secs. BM 6.4
Pupils 5mm react to light equally.
Bloods, ECG, Xray or CT scan unobtainable without violent
struggle/sedation
so decide to wait and see.
What should I have done?
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