A 21-Year-Old Hospitalized Man Is Evaluated for Confusion

A 21-year-old hospitalized man is evaluated for confusion.  He was admitted 2 days ago after an all-terrain vehicle rolled on top of him.  He frequently binge-drinks alcohol and was drinking just prior to the incident.  The patient has a right femoral midshaft fracture and right metatarsal fractures.  He underwent operative fixation of the femoral fracture and received intravenous fluids and a blood transfusion.  Cast immobilization of the metatarsal fractures was also performed.  Temperature is 37.7 C (99.9 F) , blood pressure is 130/80 mm Hg, pulse is 120/min, and respirations are 24/min.  Pulse oximetry is 90% on room air and improves to 95% on 2 L of oxygen.  The patient is restless, agitated, and confused.  Breath sounds are normal and equal in both lungs.  Cardiac auscultation is normal except for tachycardia.  The abdomen is soft and nondistended.  Left arm weakness is noted.  Which of the following is the most likely cause of this patient's neurologic condition?

A) Alcohol withdrawal
B) Carotid dissection
C) Cerebral embolism
D) Cerebral hemorrhage
E) Cerebral vasospasm
F) Diffuse axonal injury

Correct Answer:

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