Xray Vision: Headache

An 88 yo M with history of HTN and CAD s/p stent on aspirin and Plavix is brought in by EMS after a fall. He states he was drinking tea in his chair last night and he fell asleep, fell out of the chair, hitting his right occiput on the floor. He denies loss of consciousness, but says he remained on the floor for a few minutes “trying to regain [his] strength.” He denies antecedent symptoms including chest pain, SOB, numbness, weakness, or trouble speaking. Currently he complains of R occipital headache radiating to his right eye, accompanied by 3 episodes NBNB vomiting at home. He took Tylenol at home without adequate relief of pain. He continues to deny numbness, weakness, dysarthria, dysphagia, vision changes, dizziness, lightheadedness, and other symptoms. You decide to get a CT scan and you see the following:

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Interpret the images. Other than consulting other services, what is your management?

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Dr. Berkowitz is an Emergency Medicine Resident at SUNY-Downstate Medical Center/Kings County Hospital.

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2 comments for “Xray Vision: Headache

  1. ablumenberg
    November 29, 2015 at 10:17 pm

    Right subdural hematoma tracking along the tentorium cerebelli, +midline shift, +compression of right lateral ventricle including collapse of temporal & occipital horns, +cerebral edema. Well pneumatized sinuses/mastoid air cells, no obvious skull fractures (not viewed in bone window), no extracranial edema. I see no blood in the subarachnoid space but hard to exclude it on these images. No blood within ventricular system, 4th ventricle patent.

  2. December 11, 2015 at 5:18 am

    Good Case! High Index of suspicion for SDH just from Hx…. a bit fussed that I didn’t see it until after it was over… hmmm

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