A 45-Year-Old Man Is Brought to the Emergency Department After

A 45-year-old man is brought to the emergency department after sustaining a traumatic head injury in a motor vehicle collision.  The patient was found unresponsive and had several generalized tonic-clonic seizures during transport.  Medical history includes hypertension as well as alcohol and cocaine misuse.  Temperature is 36.7 C (98.1 F) , blood pressure is 170/96 mm Hg, pulse is 50/min, and respirations are 10/min.  Pulse oximetry shows 98% on mechanical ventilation with 50% oxygen.  On examination, the patient is comatose with midpositioned and fixed pupils and rigid extension of the upper and lower extremities.  Noncontrast CT scan of the head is shown in the image below: Damage to which of the following structures is the most likely explanation for this patient's abnormal posturing?

A) Cerebellar vermis
B) Cerebral hemisphere
C) Cervical spinal cord
D) Internal capsule
E) Pons
F) Substantia nigra
G) Thalamus

Correct Answer:

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