Approach to traumatic brain injury Quiz: Ace Your Exams

A 20-year-old college student is brought to the emergency department (ED) after being hit in the head by a baseball during a game. The student’s coach states that he appeared to have a brief loss of consciousness immediately after the incident, but he was then able to ambulate on his own and was behaving normally on the sidelines. However, over the last hour, he has become increasingly drowsy, and he had one episode of emesis en route to the ED. On arrival, the patient’s temperature is 36.8 °C (98.2 ºF), pulse is 65/min, respiratory rate is 10, blood pressure is 118/82 mmHg, and SpO2 is 98% on room air. Primary survey is notable for GCS of 13. Secondary survey demonstrates swelling on the right temporoparietal scalp and no focal neurologic deficits, although the patient is difficult to rouse and falls asleep when not actively stimulated. What type of cranial imaging should be obtained, and what is the most likely imaging finding based on this patient’s clinical history and presentation?