Case 34-2007

A 77-year-old man was admitted to the hospital because of difficulty speaking and altered mental status. He had been well until the day before admission, when pain developed in the right side of the face and in the right ear. Several days earlier, he had fallen on the sidewalk and hit his head. On examination, he was lethargic with incomprehensible speech; dried blood was seen in the right ear canal. CT scanning of the head disclosed pneumocephalus and opacification of the right mastoid air cells.