A 4-Year-Old Boy with Sickle Cell Disease Is Brought to the Emergency

A 4-year-old boy with sickle cell disease is brought to the emergency department by his parents due to a progressive headache and drowsiness.  While coming down the stairs, the patient slipped and fell from a height of 1.5 m (5 ft) , hitting his head on the tile floor.  He lay on the ground for several seconds but got up and continued walking and talking normally.  The patient initially had only mild pain at the injury site.  A few minutes later, he developed a progressive headache and vomiting before becoming somnolent.  The patient has been hospitalized multiples times for vasoocclusive crises.  He takes hydroxyurea and penicillin daily.  Blood pressure is 140/86 mm Hg and pulse is 66/min.  The patient is sleepy and requires painful stimuli to remain awake.  On neurologic examination, the left pupil is 3 mm with normal pupillary reflex, but the right pupil is 8 mm and unreactive to light.  Which of the following is the most likely cause of this patient's acute decompensation?

A) Cerebral contusion
B) Epidural hematoma
C) Ischemic stroke
D) Subarachnoid hemorrhage
E) Subdural hematoma

Correct Answer:

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