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> Maybe the teaching point here is to do a funduscopic exam
--> This does not strike me as the teaching point.
In my opinion, the "message" here is that quite a number of clinical signs which are TYPICAL for any one condition are NOT 100% reliable rule-out even when we are certain they are absent. Fundoscopy MIGHT have been abnormal, but, just like all the other "surprises" here, it might have been a false negative as well.
It's a surprising finding on imaging, certainly. Very interesting.
BTW, this sort of patient would not have been taken to this length of investigation in our ED, but would have been done via some other (non-emergency) service.
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