A 69-year-old Man with Sudden Loss of Consciousness, Non-reactive Pupils, and a Bilateral Positive Babinski Sign

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A 69-year-old Man with Sudden Loss of Consciousness, Non-reactive Pupils, and a Bilateral Positive Babinski Sign

Journal Title: Advanced Journal of Emergency Medicine - Year 2018, Vol 2, Issue 3

Abstract

KEY QUESTIONS: • What are the pathologic findings in figure 1? • What is the importance of these findings? • What other diagnostic modalities can be used for a definite diagnosis? LEARNING POINTS: Pathologic findings In figure 1, the basilar artery appears homogenously hyperdense in comparison with the adjacent left middle cerebral artery (MCA), using brain parenchyma as a reference point; thus indicating a hyperdense basilar artery sign (HBAS) (Figure 2, white arrow). Also, the right superior cerebellar artery and left posterior cerebral artery appear to be hyperdense (Figure 2, the red and green arrows, respectively). This is called a hyperdense artery sign (HAS). The artery becomes hyperdense because the intra-arterial clotted blood has a higher Hounsfield unit (80 HU) than the non-clotted flowing blood (40 HU) and thus appears white on non-contrast computed tomography (CT) scan. Pathologically, high hematocrit levels and calcium deposits in the vessel wall (due to arteriosclerotic disease) can result in an incorrect diagnosis of HAS. Sometimes, infections or tumors can make the brain parenchyma surrounding the vessel hypodense, which can give the false impression of a hyperdense vessel.

Authors and Affiliations

Mehran Sotoodehnia, Mehrnoosh Aligholi-Zahraie

Keywords

Nebulized Budesonide vs. Placebo in Adults with Asthma Attack; a Double Blind Randomized Placebo-Controlled Clinical Trial

Introduction: Asthma is one of acute respiratory diseases leading to emergency department (ED) referral. Management of acute attack plays an important role in its outcome. Objective: This trial was designed to evaluate t...

EP ID EP378257
DOI 10.22114/ajem.v0i0.86
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