Case No. 54

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Case No. 54


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Chief Complaint:

Headache and Altered Mental Status

Published: July 5, 2017
Author: Medzcool

A 53-year-old woman presents to the emergency department for a headache. Symptoms started suddenly 1 hour prior to arrival. She is accompanied by a friend who says she began having slurred speech which is what prompted them to seek medical attention, however on route deteriorated in her mental status. On exam she is now obtunded, pupils are pinpoint and minimally reactive. Blood pressure is 260/140 and heart rate is 60. A head CT is obtained, showing the following (see media).


What is the most likely diagnosis?

  • Carotid artery dissection with intraventricular extension
  • Cerebellar hemorrhage with intraventricular extension
  • Pontine hemorrhage
  • Subcortical hemorrhage

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