Match each classic clinical and radiographic presentation with the most likely neurosurgical diagnosis or herniation syndrome.
- A 25-year-old man develops a transient loss of consciousness after head trauma, wakes up, and then rapidly deteriorates; CT shows a biconvex hyperdensity.Epidural hematoma
- An 80-year-old man presents with progressive confusion over 3 weeks following a minor fall; CT shows a crescent-shaped extra-axial fluid collection.Subdural hematoma
- A 45-year-old woman presents with the sudden onset of the 'worst headache of my life'; CT shows hyperdensity within the basal cisterns.Subarachnoid hemorrhage
- A patient with an expanding temporal lobe mass develops an ipsilaterally dilated, unreactive pupil and contralateral hemiparesis.Uncal herniation
Answer
Epidural hematoma matches the biconvex lesion with a lucid interval. Subdural hematoma matches the crescent-shaped subacute collection. Subarachnoid hemorrhage matches the thunderclap headache with basal cistern blood. Uncal herniation matches the ipsilateral blown pupil and contralateral hemiparesis.
Each classic neurosurgical emergency has defining radiographic and clinical features. Epidural hematomas present with a lucid interval and biconvex hyperdensity. Subdural hematomas are crescentic and common in the elderly after minor trauma. Subarachnoid hemorrhages present with a sudden, severe headache and blood in the basal cisterns. Uncal herniation presents with an ipsilaterally dilated pupil and contralateral hemiparesis due to compression of local midbrain structures.
Step-by-Step Solution
Key Concept
Classic clinical presentations and neuroimaging findings of common intracranial hemorrhages and herniation syndromes.