Question

A 72-year-old woman with a history of smoking, diabetes, hypertension, hyperlipidemia, and myocardial infarction presents to your emergency room by ambulance with an acute onset of obtundation with dense right hemiplegia, right hemisensory loss to light touch, pain and temperature, and mutism. You suspect a left lobar hemorrhage because of the acuity of onset of her symptoms and a blood pressure reading of 210/100 mm Hg in the emergency room. Once stabilized, the best immediate diagnostic test of choice from the emergency room would be:

A. Lumbar puncture with opening pressure and CSF assay for xanthochromia
B. Brain MRI scan without gadolinium
C. Blood work for coagulation panel (PT, PTT [partial thromboplastin time], INR [international normalized ratio])
D. Noncontrast head CT scan
E. Routine bedside electroencephalogram (EEG)

Answer 1

For a suspected left lobar hemorrhage in an elderly patient, the best immediate diagnostic test is a Noncontrast head CT scan, as it provides rapid assessment crucial for stroke management.

Step-by-step explanation:

The best immediate diagnostic test of choice for a 72-year-old woman presenting with acute onset of obtundation, dense right hemiplegia, and mutism, suspecting a left lobar hemorrhage, is a Noncontrast head CT scan. This diagnostic tool is crucial in the acute setting for identifying hemorrhagic strokes, as it can quickly detect the presence of blood within the brain tissue and help distinguish between ischemic and hemorrhagic stroke. It is less time-consuming than an MRI and can be more readily available in most emergency rooms, allowing for rapid assessment and management, which is essential in acute stroke patients.