Match each clinical presentation to its most likely neurosurgical diagnosis.
- A 22-year-old struck in the head with a baseball presents with brief loss of consciousness, a lucid interval, and subsequent rapid neurological decline.Epidural hematoma
- An 81-year-old with a history of falls presents with insidious onset of confusion, headache, and a crescent-shaped hyperdensity on head CT.Subdural hematoma
- A 45-year-old presents to the emergency department with the sudden onset of a 'thunderclap' headache, photophobia, and nuchal rigidity.Subarachnoid hemorrhage
- A 60-year-old man involved in a rear-end motor vehicle collision develops bilateral upper extremity weakness with relative sparing of the lower extremities.Central cord syndrome
Answer
The lucid interval points to an epidural hematoma. The elderly patient with a crescent-shaped CT finding has a subdural hematoma. The 'thunderclap' headache represents a subarachnoid hemorrhage. The upper extremity-predominant weakness after a rear-end collision indicates central cord syndrome.
Each vignette represents a highly classic presentation of a distinct neurosurgical condition. Recognizing these 'textbook' patterns is essential for rapid diagnosis and management on the USMLE Step 2 exam.
Step-by-Step Solution
Key Concept
Diagnosis of common neurosurgical emergencies based on classic clinical presentations.