Skip to Main Content


An 84-year-old woman was admitted to another hospital 4 days earlier for weakness of her left arm and leg that had begun 2 days prior to that admission. A head CT was performed and she was diagnosed as having a stroke. Her family became concerned that “nothing was being done.” They signed her out of that hospital and transported her to the ED.


The CT obtained in the ED is shown in Figure 1.


  • What was the patient’s likely diagnosis?
  • What other tests are needed to confirm the diagnosis?

++ ++

Although this patient presented with a focal neurological deficit and the CT showed cerebral edema in the corresponding region of the right cerebral hemisphere, the patient’s disorder was not an ischemic stroke. The subcortical white mater has a very low attenuation, while the gray matter is relatively normal in appearance. There is an accentuation of the gray/white matter interface, as opposed to the loss of the gray/white interface seen with an acute ischemic stroke (cytotoxic edema) (Figure 2, and see also Patient 9).


In addition, there is considerable mass effect due to the cerebral edema, although its effect is moderated by the patient’s underlying age-related cerebral atrophy. The cortical sulci are effaced in comparison to the wide cortical sulci and atrophic gyri of the opposite cerebral hemisphere. The right lateral ventricle is compressed, although there is ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.