Detailed Treatment Process
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Male, 44 years old, with a history of moderate to heavy alcohol consumption for over 20 years. He developed pain the previous day that persisted for one full day without fever. The following day he suddenly lost consciousness and fainted. Half an hour later he was brought to the hospital by ambulance; this was a Saturday. He was admitted at 13:11. On admission physical examination showed normal muscle strength in all four limbs and negative pathological reflexes. Emergency head CT was performed. The report indicated obvious narrowing of the ambient cistern with fullness of surrounding structures. Radiology recommended further MRI to rule out space-occupying lesions.
Radiology Report Examination time: June 1, 12:06 Examination: Non-contrast head CT with three-dimensional reconstruction Radiological findings: The bilateral cerebral hemispheres, cerebellum, and brainstem appeared normal in morphology with no obvious abnormal density lesions. The lateral ventricles, third ventricle, and fourth ventricle were normal in morphology and density. The ambient cistern was obviously narrowed. The other sulci, fissures, and cisterns showed no widening or morphological changes. Midline structures were midline. Radiological impression: Obvious narrowing of the ambient cistern. MRI is recommended to further exclude intracranial space-occupying lesions or cerebral infarction. Report time: June 1, 13:11 Reviewed by: [signature] Time: June 1, 13:12
Based on the CT report and the patient’s headache, the emergency physicians initially started treatment for suspected cerebral infarction. During this period, the emergency department did not request a neurosurgical or neurological consultation. The patient remained under observation in the emergency observation area. Around 17:30 he suddenly became unresponsive, developed generalized convulsions, urinary incontinence, and could not be aroused. Both pupils were fixed but still reactive to light. At this point the emergency physicians began to consider cerebral hemorrhage. Mannitol was given to reduce intracranial pressure, and sodium valproate was continued for seizure control. At 22:30 transfer to another facility was arranged and the ambulance had arrived, but the patient again lost consciousness with convulsions and urinary incontinence. Transfer was not possible and resuscitation continued at the current hospital. Around 23:00 a repeat head CT was performed, which clearly showed signs of intracranial hemorrhage.
* Radiology Report Department: Neurology Examination time: June 1, 22:51 Clinical impression: To be determined. Requested by: [physician] Examination: Non-contrast head CT with three-dimensional reconstruction Radiological findings: The bilateral cerebral hemispheres, cerebellum, and brainstem appeared normal in morphology with no obvious abnormal density lesions. High-density shadows were present in the third ventricle, fourth ventricle, interpeduncular cistern, and pontine cistern. The margins around the pons were indistinct and the tentorium cerebelli showed increased density. Sulci, fissures, and cisterns showed no widening or morphological changes. Midline structures were midline. Radiological impression: Possible hemorrhage in the third ventricle, fourth ventricle, interpeduncular cistern, and pontine cistern. Indistinct margins around the pons. Please correlate with clinical findings and follow up. This is an emergency preliminary report and has not been reviewed by a senior radiologist. Report time: June 1, 23:33
At 23:02 neurosurgery arrived in the emergency department for on-site consultation—more than 10 hours after the patient’s arrival. Approximately one hour later the patient died.