Question 2124

Question contributed by Francis Deng ◉

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A patient without prior medical history was involved in a motor vehicle collision and arrives obtunded. The patient undergoes noncontrast CT of the head and cervical spine. At the acquisition scanner, you identify scattered convexal subarachnoid hemorrhage and fractures of the right petrous temporal bone, characterized as otic-capsule sparing, coursing to the sigmoid plate, and not clearly involving the petrous carotid canal on that side. Based on this information, which of the following imaging tests is the most appropriate next step?

CT angiography: arterial phase only of the head and neck

CT angiography: arterial phase of the head and neck plus venous phase of the head

CT of the head and neck with contrast (brain parenchymal/soft tissue phase)

MRI brain without contrast, MR angiography of the head without contrast, MR angiography of the neck with contrast plus axial T1 precontrast with fat saturation at the skull base, and MRI of the cervical spine without contrast

point-of-care ultrasound of the carotid arteries and jugular veins

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Question 2124

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