"This is a fairly classical presentation. It is too often missed by "casual" readings by a "fly-by-night" radiologist and ER-physician.

The major clue is patients age and the absence of "geographical" markers - It underscores the necessity of reading the CT yourself and keeping the clinical picture in mind.  - Very Good case.  Dr. Sackett did not live in vain (I only met him early in his Wisconsin career - and in the very easy days of CT in Madison)

Lesson: Always compare the clinical and the graphics."

"Great presentation Dr. Brodkey!  One additional method for temperature management that may be worth including (I do have a conflict of interest) is core temperature control through esophageal heat transfer.  A device designed to do just this (mimicking gastric lavage to some extent, but without relying on actual instillation of free liquid into the GI tract) is the Esophageal Cooling/Warming Device.  A growing body of literature is emerging showing quite good performance and ease of use, making it perhaps a solution for a number of sites that would prefer to initiate core cooling without needing large capital purchases (since the device utilizes existing water blanket chillers).  More details can be found at the link below."