Case: 43-year-old Woman with Altered Mental Status

by Roy Strowd, MD

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    00:01 In this talk, let's review subarachnoid hemorrhage.

    00:05 And let's start with a case.

    00:07 This is a 43 year-old woman with a history of migraines and depression who presented after having been found altered at her home.

    00:14 She was found down by her son.

    00:16 EMS was called and Naloxone was administered concern for a drug overdose without improvement.

    00:22 She was taken to a local emergency room for evaluation where examination shows that her eyes were closed.

    00:28 She was groaning to tactile stimulus, she does not follow exam and was withdrawing her extremities symmetrically throughout.

    00:35 So this is a patient with a significant injury, a reduced Glasgow Coma Scale.

    00:40 This is a medical emergency.

    00:43 The patient underwent CT imaging and we're looking at a non-contrast head CT on the left and a contrasted CTA on the right.

    00:50 On the left, this non-contrasted scan, we see hyperdense material blood in multiple areas throughout the brain.

    00:57 It's almost like it's lighting up the course of the blood vessels.

    01:01 On the right, we're looking at a CTA.

    01:03 And we see in the right internal or initial in MCA middle cranial artery, an outpouching or bulging of that artery that may be a cause of concern.

    01:15 So what's the most likely diagnosis? Is this an epidural hematoma, subdural hematoma, subarachnoid hemorrhage or glioblastoma? Well, this is not an epidural hematoma.

    01:25 Those appear on imaging as a lens-shaped lesion, we often hear of a lucid interval, and none of those things are the case for this patient.

    01:33 This is not a glioblastoma, there was no tumor on the brain.

    01:36 This patient's clinical presentation is inconsistent with what we would expect for a tumors presentation.

    01:43 This doesn't look like a subdural hematoma.

    01:45 The patients with subdural hematoma present with a slowly progressive course.

    01:50 This patient had a sudden headache and alteration of mental status now with blood all throughout the brain.

    01:57 And this is a classic presentation of a patient with subarachnoid hemorrhage, including both the clinical presentation and the imaging.

    About the Lecture

    The lecture Case: 43-year-old Woman with Altered Mental Status by Roy Strowd, MD is from the course Head Trauma.

    Included Quiz Questions

    1. Subarachnoid hemorrhage
    2. Glioblastoma
    3. Epidural hematoma
    4. Subdural hematoma
    5. Ischemic stroke
    1. Acute bacterial meningitis
    2. Intraparenchymal hemorrhage
    3. Subdural hematoma
    4. Neurocysticercosis
    5. Toxoplasmosis

    Author of lecture Case: 43-year-old Woman with Altered Mental Status

     Roy Strowd, MD

    Roy Strowd, MD

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