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A 60-year-old man is brought to the emergency room one hour after developing the sudden onset of headache. He appears confused to time and space, and is only able to tell his name and date of birth. The right pupil is dilated and poorly reactive to light. His wife relates that he has suffered from hypertension since the age of 40, but has not taken his antihypertensive treatment regularly. His temperature is 37 C (98.4 F), blood pressure is 170/100 mm Hg, pulse is 80/min and regular, and respirations are 20/min. Which of the following is the most appropriate next step in diagnosis?
A. Electroencephalographic examination
B. CT scan of the head
C. MRI scan of the head
D. Toxicological analysis of blood and urine
E. Lumbar puncture for CSF examination
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c. because f post circulation symptoms?
mri is also the choice inv in strokes after 48 hours..while ct before 48 hours
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Hi
Friend
It was the post circulation symptoms. It can be the stroke or minor infarct .
I want to know it.
I choose the answer B in this case.
Am I right.
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The correct answer is
B. The history of poorly treated hypertension helps in the diagnosis. A hypertensive intracerebral bleeding should be suspected. CT studies of the brain are the most sensitive for detection of acute bleeding. MRI scan of the head (choice C) is usually more sensitive than CT scan for studies of intracerebral lesions, but less accurate in the early diagnosis of intracranial bleeding.
Electroencephalographic examination (choice A) would show non-diagnostic changes.
Toxicological analysis of blood and urine (choice D) are most useful in investigating coma of unknown origin. In particular, toxicological screening of urine may provide useful information in cases of suspected poisoning or intoxication.
Lumbar puncture for CSF examination (choice E) would not be advisable since this patient has evidence of increased intracranial pressure with uncal herniation (i.e. oculomotor paresis).
