Clinical Vignette A 50-year-old woman is referred to a neurologist because of severe headaches. She first developed headaches during adolescence, and they worsened in the setting of menopause. A typical headache is unilateral and localized to the right frontotemporal and…
Clinical Vignette After a day of skiing, six teenagers packed into a small hatchback on their way home. Conditions were icy, and the driver lost control of the vehicle near the base of the mountain, rear-ending another vehicle at approximately…
Traumatic brain injury (TBI) is a worldwide major source of lifelong morbidity and mortality. It is the leading cause of death in North America for individuals between the ages of 1 and 45. The societal cost is substantial, with approximately…
Clinical Vignette A 45-year-old man with a history of bipolar disorder and binges of alcohol abuse gradually developed global headaches that abruptly worsened over a 6-day period. He presented to the emergency room with excruciating headaches, especially while lying flat…
Clinical Vignette A 66-year-old woman experienced the near immediate onset of a terrible temporal pain that radiated into her forehead. She almost lost consciousness. She became nauseated, vomited, and felt disoriented. Her family called emergency medical services, who brought her…
Clinical Vignette A 40-year-old right-handed man with a past medical history significant for hypertension presented to the emergency department (ED) via ambulance with sudden-onset right hemiparesis. He did not take antithrombotic medications. His initial blood pressure was 184/93 mm Hg. The…
While in recent years ischemic stroke has dropped to the fifth most frequent cause of death in the United States, it remains a leading cause of morbidity, mortality, and long-term disability worldwide with a devastating impact on patients, families, and…
The brain and meninges are supplied by arteries derived from the common carotid artery (CCA) and vertebrobasilar system ( Fig. 14.1 ). The right CCA usually originates from the brachiocephalic trunk, whereas the left CCA originates directly from the aortic…
Coma Clinical Vignette A 57-year-old man with coronary artery disease develops severe chest pain and heaviness on exertion, then loses consciousness while working in the garden with his wife. Emergency Medical Services is called immediately and arrives at the scene…
Clinical Vignette A 62-year-old man with hypertension and diabetes mellitus type 2 was brought to the emergency department via Emergency Medical Services for evaluation of acute onset of obtundation. Over the course of approximately 1 minute, he changed from being…