History:

A patient in their early 20’s who tripped and fell while drinking is brought from a saloon to the ER by medics.  He hit his head and was stunned but does not think he was not knocked out.  He is not on blood thinners and denies any significant medical history.  He has a headache, which has not improved but no vomiting, neck pain or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is also normal except for a large hematoma to the forehead

Initial Diagnostic Testing:

What is the most likely diagnosis?

  • A) Subarachnoid bleed
  • B) Intraventricular bleed
  • C) Colloid cyst
  • D) Calcified pineal gland

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

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ANSWER:

  • A) Subarachnoid bleed – can have a similar look, but in a more caudal location – LINK
  • B) Intraventricular bleed
  • C) Colloid cyst – CORRECT
  • D) Calcified pineal gland – would be more dense and in a different location – LINK

CASE CONCLUSION: Was referred to neurosurgery for surveillance

 

1-Minute Consult on Colloid Cyst

  • Hyperdense, often in 3rd ventricle, can rarely bleed
  • Often an incidental finding on head CT
  • Treatment:  Arrange neurosurg f/u, may bleed or obstruct CSF flow

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