IMAGES IN EMERGENCY MEDICINE

John Rob Miller, MD; Chad M. Cannon, MD

0196-0644/$-see front matter
Copyright © 2017 by the American College of Emergency Physicians.
http://dx.doi.org/10.1016/j.annemergmed.2017.04.020

Figure 1. CT of the head (scout view) demonstrating extensive Figure 3. CT of the head (axial view) obtained 8 years before
anterior pneumocephalus. this ED presentation, with baseline moderate hydrocephalus.

Figure 2. CT of the head (axial view) showing extensive anterior Figure 4. CT of the head (axial view) obtained at 3-month
pneumocephalus with underlying moderate hydrocephalus. follow-up after shunt placement. The shunt is visualized in the
right lateral ventricle, with improved hydrocephalus.

[Ann Emerg Med. 2017;70:597.]

A 40-year-old woman with a history of hydrocephalus presented to the emergency department (ED) for evaluation of
severe headache. Her symptoms started suddenly 2 days previously, with associated positional vertigo and a “swishing”
sound within her head. On examination, the patient exhibited ataxia with horizontal nystagmus and positional vertigo.

For the diagnosis and teaching points, see page 603.

To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com

Volume 70, no. 4 : October 2017 Annals of Emergency Medicine 597


http://dx.doi.org/10.1016/j.annemergmed.2017.06.013
Funding and support: By Annals policy, all authors are
required to disclose any and all commercial, financial, and
other relationships in any way related to the subject of this
article as per ICMJE conflict of interest guidelines (see
www.icmje.org). The authors have stated that no such
relationships exist.
Volume 70, no. 4 : October 2017
Correspondence
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Annals of Emergency Medicine 603