Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Acute Loss of Consciousness
Consult Page
35F found down, head CT with bleed, bradycardic now
Initial Imaging
Walking Thoughts
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What is the patient’s GCS? How is her airway, breathing, and circulation?
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When was the patient last seen normal? How long was she down for?
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Does the patient have any coagulopathies?
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There is significant mass effect on the head CT. Has the emergency department (ED) maximized medical management of her intracranial pressure (ICP)?
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The patient is young—could the bleed be due to a vascular malformation? Is a CT angiogram (CTA) ordered to check for an underlying vascular lesion?
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Does the patient need an emergent procedure such as an external ventricular drain (EVD) or a hemicraniectomy?
History of Present Illness
A 35 year old female with a history of diabetes and a prior pregnancy complicated with eclampsia was brought to the ED after being found down. Per family, the patient was complaining of headache, nausea, and vomiting in the morning. A few hours later, she was found down by her family unresponsive with irregular breathing. The family called emergency medical services, and she was intubated upon their arrival.
In the ED, the patient’s blood pressure was 211/141, and she was started on a nicardipine drip. Emergent head CT without contrast demonstrated extensive right intraparenchymal and bilateral intraventricular hemorrhage, as well as obstructive hydrocephalus with concomitant midline shift. During the scan, the patient became bradycardic, and neurosurgery was emergently consulted.
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