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Student Education

Head injury and left sided weakness

BMJ 2008; 336 doi: https://doi.org/10.1136/sbmj.0806243 (Published 01 June 2008) Cite this as: BMJ 2008;336:0806243
  1. Senthil K Selvanathan, foundation year two doctor1,
  2. Sundip D Udani, senior house officer and anatomy demonstrator2,
  3. Rebecca D Udani, foundation year two doctor3,
  4. Tony Goldschlager, registrar in neurosurgery4,
  5. Jeffrey V Rosenfeld, professor and director of neurosurgery4
  1. 1Department of Surgery, Manchester Royal Infirmary
  2. 2University of Manchester Medical School
  3. 3Accident and Emergency Department, Royal Preston Hospital
  4. 4Department of Neurosurgery, Royal Alfred Hospital, Melbourne, Australia

A 77 year old man fell on an icy pavement on to his left shoulder and cut his head. He did not lose consciousness. Six weeks later while watching television he noticed his left arm shaking. This lasted for about 50 seconds. In the next 10 days he kept dropping things when using his left hand. He also kept veering to the left while driving, coming close to parked cars. He noticed that he had been feeling increasingly drowsy and had some right sided headache.

On examination he had a left hemiparetic gait. His right pupil was larger and less reactive to light. He had a noticeable facial weakness because of the left upper motor neurone; left sided pyramidal weakness; and a left extensor plantar. He had no sensory loss of note. A computed tomogram of the head was arranged.

Questions

  • (1) How can this patient's symptoms be explained?

  • (2) What are the differential diagnoses?

  • (3) What are the radiological findings (fig 1)?

  • (4) How is this condition managed?

Computed tomogram of the head

Answers

  • (1) …

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