Case #1 Answers:
Answer 1
Mr.
Howard has had an acute in mental status with decreased consciousness. Given
the findings on neurological examination, the sleepiness, and the history of
coumadin use, one must be very concerned about an intracranial bleed, especially
the possibility of a sub-dural hematoma.
Answer 2
Mr.
Howard needs a CT scan. An MRI would not be as good as the CT scan is the test
of choice to detect intracranial bleeding.
Answer 3
The
emergent CT scan can be justified by the acute changes and the plan to obtain
neurosurgical consultation and drainage if a subdural hematoma is found.