Correct!
3. Begin an anticonvulsant and dexamethasone
Correct therapy relies upon correct interpretation of the CTA of the head. CTA did not show an acute intracranial hemorrhage, but there were ring-enhancing lesions in the right superior thalamus, right occipital, and left posterior frontal regions. This is most consistent with metastases to the brain. An anticonvulsant should be prescribed because of the high risk of seizures along with dexamethasone to improve symptoms by controlling cerebral edema.
Administration of TPA would be appropriate for a thrombotic stroke. However, administration of TPA in this patient's situation is potentially dangerous and could result in an intracranial hemorrhage. Coiling or stereotactic radiosurgery are appropriate for multiple arteriovenous malformations (AVMs). However, the ring-enhancing lesions in this patient's CTA are not consistent with AVMs.
What is the next step in the patient's evaluation? (Click on the correct answer to proceed to the third of six panels)