Case of the Month 2018:2

EANS Case of the Month 2018:2 – 'When All Hematomas Are Not The Same'

Aristotelis Filippidis, MD PhD and Ekkehard Kasper, MD PhD
Department of Surgery, Division of Neurosurgery; Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA USA

A 68 years old, right-handed female presented to urgent care in hypertensive crisis and with a severe headache. Her past medical history (PMH) revealed smoking, hypertension (on lisinopril) with previous episodes of hypertensive crisis, an old left inferior frontal infarct with residual right arm 4/5 weakness, a patent foramen ovale, hyperlipidemia, depression and insomnia. She reported no recent trauma and she was taking aspirin 81mg daily.

Question Title

* 1. What is the appropriate next step?

Treat the hypertension until the patient’s blood pressure elevation (BP) and symptoms resolve, then admit to Medicine for monitoring and medication adjustment for BP control.

Treat hypertension and obtain a CT non contrast head scan (NCHCT).