“Something doesn’t add up…” Case Conclusion April 6, 2012
Posted by Andy Jagoda, MD in: Cardiovascular, Neurologic, Trauma , trackback
The Conclusion Is…
A subdural or epidural hematoma would have to be extensive to cause hemiparesis, hemisensory loss, and neglect. A Todd paralysis after seizure was possible, but was considered only after ischemic causes were ruled out. Since the initial noncontrast head CT showed a small subdural hematoma, ischemic stroke was the next most-worrisome possibility. Concern for dissection should be raised when ischemic stroke is considered in the setting of trauma. A CTA was obtained that showed near occlusion of the right internal carotid artery. IV tPA was not administered for this traumatic dissection for concern of worsening or creating hemorrhagic complications. Interventional neuroradiology was consulted immediately, and the patient was placed on a heparin infusion as a bridge to the procedure. Stenting of the vessel was performed, and though it was not successful in reversing her neurological deficits, it may have prevented further ischemic damage.
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