Case 34-2007 -- A 77-Year-Old Man with Ear Pain, Difficulty Speaking, and Altered Mental Status

doi:10.1056/NEJMcpc079028

Volume 357:1957-1965		November 8, 2007		Number 19

Case 34-2007 — A 77-Year-Old Man with Ear Pain, Difficulty Speaking, and Altered Mental Status

Martin A. Samuels, M.D., R. Gilberto Gonzalez, M.D., Ph.D., Arthur Y. Kim, M.D., and Anat Stemmer-Rachamimov, M.D.

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Presentation of Case

A 77-year-old right-handed man was admitted to the hospitalbecause of the recent onset of pain in the ear, difficulty speaking,and altered mental status. The patient had been well until theday before admission, when he awoke in the morning with nasalcongestion and pain on the right side of his face. That evening,pain, accompanied by drainage, developed in the right ear; hiswife administered ciprofloxacin eardrops. The next morning,the temperature was 37.8°C. At about 9 a.m., the patient'swife noted that his speech was slurred. The patient said hewas tired and retired to nap. Ninety . . . [Full Text of this Article]

Differential Diagnosis

Otorrhea

Pneumocephalus

Pros and Cons of Lumbar Puncture

Aphasia

The Organism

Defects of the Tegmen Tympani

Summary

Clinical Diagnosis

Dr. Martin A. Samuels's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Department of Neurology, Brigham and Women's Hospital (M.A.S.); the Departments of Radiology (R.G.G.), Infectious Diseases (A.Y.K.), and Pathology (A.S.-R.), Massachusetts General Hospital; and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.Y.K.), and Pathology (A.S-R.), Harvard Medical School.