Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Headaches And Vomiting


Consult Page

8F presents with headache, vomiting. CT shows intraparenchymal hemorrhage.

Initial Imaging

Figure 28.1, An axial head CT without contrast demonstrates an acute large left frontal intraparenchymal hemorrhage with extension into the body of the left lateral ventricle. There is moderate associated edema and 5 mm of midline shift.

Walking Thoughts

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    Have the ABCs of airway, breathing, and circulation been addressed?

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    What is the patient’s current GCS?

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    Was there any witnessed trauma or evidence that this might be a traumatic injury?

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    Does the patient have any comorbidities that would predispose her to stroke, vascular malformations, malignancy, or clotting disorders?

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    Does the patient need an external ventricular drain (EVD)?

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    Does the patient need to go to the operating room (OR) urgently for decompression?

History of Present Illness

An 8 year old female presents with headache, nausea, vomiting, and intermittent confusion. The morning prior, the patient woke up complaining of headaches and subsequently vomited. The patient’s mother noted that she was intermittently confused and sleepy, and this progressed throughout the day prior and last night. This morning, her symptoms have persisted and have not improved, and because of this, her mother brought her to the emergency department (ED) for evaluation. There was no witnessed fall or trauma. There is no recent travel or signs of infectious illness, and there are no abnormal movements or seizure activity. A head CT without contrast demonstrates a large left frontal intraparenchymal hemorrhage with intraventricular extension. An ultrafast MRI shows a nidus concerning for a possible arteriovenous malformation ( Figure 28.2 ).

Figure 28.2, An axial T1-weighted brain MRI with contrast demonstrates the known hemorrhage with flow voids seen adjacent to the clot suggestive of an AVM (arrow).

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