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A 77-year-old right-handed man was admitted to the hospital because of the recent onset of pain in the ear, difficulty speaking, and altered mental status. The patient had been well until the day before admission, when he awoke in the morning with nasal congestion and pain on the right side of his face. That evening, pain, accompanied by drainage, developed in the right ear; his wife administered ciprofloxacin eardrops. The next morning, the temperature was 37.8°C. At about 9 a.m., the patient's wife noted that his speech was slurred. The patient said he was tired and retired to nap. Ninety
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.
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