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Case: 43-year-old Woman with Altered Mental Status
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Slides Head Trauma Subarachnoid Hemorrhage.pdf
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Download Lecture Overview
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
In a patient with a history of headaches, a sudden-onset headache that is more severe and different in character than their usual headaches should prompt consideration of which diagnosis?
- Subarachnoid hemorrhage
- Glioblastoma
- Epidural hematoma
- Subdural hematoma
- Ischemic stroke
In a patient who presents with findings similar to subarachnoid hemorrhage—including sudden onset headache and lethargy—as well as with a fever, what diagnosis must be considered?
- Acute bacterial meningitis
- Intraparenchymal hemorrhage
- Subdural hematoma
- Neurocysticercosis
- Toxoplasmosis
Author of lecture Case: 43-year-old Woman with Altered Mental Status
Roy Strowd, MD
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