Approach to differentiating lesions (cerebellum) Quiz: Ace Your Exams

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A 56-year-old woman is admitted to the hospital for coronary angiography. During the procedure, there is an acute onset of severe headache and vertigo. The patient becomes markedly confused and begins vomiting. Medical history includes uncontrolled hypertension, dyslipidemia, and chronic angina. Medications include aspirin, spironolactone, ramipril, bisoprolol, furosemide, and atorvastatin. Temperature is 37.0°C (98.6°F), pulse is 105/min, respirations are 22/min, and blood pressure is 210/110 mmHg. On examination, the patient appears confused with nystagmus, dysarthria, and dysphagia. Speech is severely impaired. There is no focal limb weakness, but an anterior-posterior rhythmic tremor of the head and upper trunk is noted. Which of the following is the most appropriate next step in management?

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Brain magnetic resonance imaging (MRI) without contrast

Intravenous (IV) tissue plasminogen activator (tPA)

Intravenous (IV) labetalol

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Computerized tomography (CT) of the head without contrast