Vomiting\Three Hospital Visits\Cerebral Infarction\Death

Male, 48 years old Vomiting began at around 3 p.m. on Friday. The patient arrived at the hospital at approximately 16:00. Emergency temporary CT report Department: Emergency Internal Medicine Clinical diagnosis: Dizziness Requesting physician: Consultation requested Examination: Head CT (plain scan, 64-slice) Radiological findings: The bilateral cerebral hemispheres are symmetric. Suspicious punctate low-density shadows are seen in the bilateral basal ganglia. No obvious abnormalities are noted in the brainstem or cerebellar hemispheres. The ventricular system is normal in size, shape, and density, with no midline shift. No obvious abnormal density shadows are seen in the bilateral cerebellopontine angle regions. The cerebral sulci, cisterns, and subarachnoid spaces appear normal. The skull structures are unremarkable. Radiological impression: Suspicious lacunar lesions in the bilateral basal ganglia. MRI is recommended. Examination time: September 23, 16:56 Report time: September 23, 17:09 The head CT report was issued at 17:09. It showed no definite abnormalities, and the radiology department suggested MRI. After the outpatient doctor reviewed the images, the patient left the hospital. At approximately 17:55, the patient returned to the hospital and requested a contrast-enhanced head study. This time he was seen by the on-duty neurologist covering the emergency department. The doctor documented a recommendation to contact the interventional department the following Tuesday for an MRI appointment. The patient left the hospital again. At 4 a.m. the next morning, the patient lost consciousness at home and was brought by family members to the same hospital’s emergency department. A repeat head CT clearly showed cerebral infarction, accompanied by impaired consciousness and hemiparesis. He died several days later. The radiology department apparently sensed something was wrong and had recommended MRI.