Bad Luck From A Puck.

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Bad Luck From A Puck. - Page #1

Author: Lauren Greene, MD Co Author #1: Sadiq Haque Senior Editor: Joseph Chorley, MD Editor: Yaowen (Eliot) Hu, MD, MBA Patient Presentation: 35 year-old previously healthy male was seen during an NHL hockey game after receiving a puck to the mastoid process of the left ear. History: 35 year-old previously healthy male was seen during an NHL hockey game after receiving a puck to the mastoid process of the left ear. He immediately removed himself from the game after the injury. He complained of immediate pain over the mastoid with moderate soft tissue swelling and bruising. He also complained of dizziness, tinnitus, headache and nausea. In addition, he denied visual changes, hearing loss, vomiting, numbness, tingling, and speech dysfunction. He has a history of two previous concussions over his lifetime, with the most recent being in 2017 (more than 2 years ago) where he subsequently missed 1 game. Physical Exam: General AOx4, baseline behavior and gait HEENT 3-4 cm tender, erythematous lesion with ecchymosis on the left mastoid process. No crepitus, TM intact, no hemotympanum or clear drainage within ear or nose. Rinne AC>BC Weber Midline CN II through XII intact, facial nerve intact Smooth pursuit normal, no nystagmus or sx Vertical/Horizontal saccade normal Near point convergence normal, 6cm Accomodation no symptoms Vestibular ocular reflex no symptoms Modified BESS testing: Romberg 0 errors/20 seconds Balance 3 errors single leg / 20 seconds 3 errors Tandem gait /20 seconds Finger to nose 5 repetitions in 4 seconds Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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