Examkin

Question

Difficulty: MediumInterpreting Imaging Results

Match each clinical presentation and corresponding non-contrast head computed tomography (CT) finding to the most likely diagnosis.

  • A 22-year-old man is struck in the temporal region by a baseball. He briefly loses consciousness, recovers fully for an hour, but then rapidly becomes comatose. Non-contrast CT reveals a hyperdense, biconvex extra-axial mass that does not cross the cranial suture lines.Epidural hematoma
  • A 78-year-old man is brought in by his family for a gradual decline in cognitive function, mild right-sided weakness, and recurrent falls over the past three weeks. Non-contrast CT shows a crescent-shaped, hypodense extra-axial collection that crosses suture lines.Chronic subdural hematoma
  • A 45-year-old woman presents to the emergency department complaining of the 'worst headache of my life' that began abruptly during exertion, accompanied by photophobia. Non-contrast CT demonstrates hyperdense material filling the basal cisterns and Sylvian fissures.Subarachnoid hemorrhage
  • A 68-year-old woman with a history of untreated atrial fibrillation presents with sudden-onset expressive aphasia and right-sided hemiparesis. Non-contrast CT obtained 2 hours after symptom onset shows loss of the insular ribbon and subtle effacement of the left lentiform nucleus.Acute ischemic stroke

Answer

The correct matches are: the trauma patient with a biconvex lesion has an epidural hematoma; the elderly patient with a crescent hypodense lesion has a chronic subdural hematoma; the patient with a thunderclap headache and basal cistern blood has a subarachnoid hemorrhage; and the patient with early insular ribbon loss has an acute ischemic stroke.
Each clinical scenario pairs with a pathognomonic neuroimaging pattern that physicians must rapidly identify to initiate life-saving interventions (e.g., neurosurgical evacuation for epidural hematoma, or permissive hypertension/thrombolysis consideration for ischemic stroke).

Step-by-Step Solution

1
Analyze the first clinical vignette and imaging finding.
Trauma, lucid interval, biconvex (lens-shaped) hyperdensity limited by sutures.
This constellation uniquely identifies an arterial bleed between the skull and dura, characteristic of an epidural hematoma.
2
Analyze the second clinical vignette and imaging finding.
Elderly patient, weeks-long decline, crescent-shaped hypodensity crossing sutures.
The hypodensity indicates older, liquefied blood. The crescent shape and ability to cross sutures define a subdural hematoma, typical in elderly patients after minor trauma.
3
Analyze the third clinical vignette and imaging finding.
Sudden severe headache, hyperdensity in basal cisterns.
Hyperdensity in the cisterns represents acute arterial blood in the subarachnoid space, diagnosing a subarachnoid hemorrhage.
4
Analyze the fourth clinical vignette and imaging finding.
Sudden focal neurologic deficits in an afib patient, loss of insular ribbon.
These are the earliest visible CT signs of middle cerebral artery (MCA) infarction (cytotoxic edema), confirming an acute ischemic stroke.

Key Concept

Recognizing the classic clinical presentations and distinct non-contrast head CT findings of life-threatening neurological emergencies.
Estimated Time:1m 30s
Rate this question

Topics

Interpreting Imaging Results

More questions from this topic