Prepared by Michael P. Phelan, MD, Staff Physician, The Cleveland Clinic Foundation, Department of
Emergency Medicine, Cleveland, Ohio
A 60-year-old woman presented to the emergency department with a change in mental status. Her medical history included hypertension, cerebrovascular accident, chronic atrial fibrillation, and chronic use of warfarin (Coumadin). Her family found her slumped over and unable to communicate. She was intermittently responding to questions and commands, but with no response to visual threat. Her pupils were equal and reactive. A computed tomography (CT) scout film (Figure 1) and noncontrast CT scans of the head (Figure 2) are shown.
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