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Cerebellar hemorrhage
58%
35/60
Pontine hemorrhage
10%
6/60
Thalamic hemorrhage
7%
4/60
Subarachnoid hemorrhage
20%
12/60
Subdural hematoma
5%
3/60
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This patient is presenting with a sudden onset severe headache and physical exam findings suggestive of cerebellar dysfunction suggesting a diagnosis of cerebellar hemorrhage. A cerebellar hemorrhage can present with variable symptoms including a sudden and severe headache, nausea or vomiting, ataxia, dizziness, nuchal pain/rigidity, and dysarthria. On physical exam, patients will often demonstrate signs of cerebellar dysfunction including an abnormal finger to nose exam, an abnormal heel to shin exam, and impaired dysdiadochokinesia. The best initial step in management is to perform a non-contrast head CT to look for signs of hemorrhage followed by reversal of anticoagulation if possible. Incorrect Answers: Answer 2: Pontine hemorrhage can present with coma within minutes. Other symptoms include total paralysis, pinpoint pupils, absent horizontal eye movements, facial palsy, deafness, and dysarthria. Answer 3: Thalamic hemorrhage can present with hemiparesis, hemisensory loss, upward gaze palsy, and unreactive/miotic pupils. Answer 4: Subarachnoid hemorrhage presents with the classic thunderclap headache as well as nausea, vomiting, and meningismus. Answer 5: Subdural hematoma can present with headache, altered mental status, and loss of consciousness. Bullet Summary: Cerebellar hemorrhage presents with a sudden and severe headache and signs of cerebellar dysfunction (ataxia, an abnormal finger to nose exam, an abnormal heel to shin exam, and impaired dysdiadochokinesia).
4.3
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