Case 4: What scan?

Clinical History

HPI: 50 year old man who presents to his primary care physician with complaints of a gradual onset of frontal headaches and new onset seizures. His PMH is notable for 20 pack year smoking history.

Question

1. What is your clinical differential diagnosis?

Answer

2. What scan would you order next?

Given that his symptoms have been gradual in onset, you could make the argument to jump straight to an MRI without and with contrast. If he were to present to the ER, a CT scan would likely be ordered as the first test. If the patient had a known diagnosis of cancer, the CT examination may be ordered without and with contrast.

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