23-year-old male medical student complains of a headache and intermittent…
23-year-old male medical student complains of a headache and intermittent fever for 2 weeks.
tension (30min-7 days)
pain is like a band squeezing the head, bilateral.
pain, nausea, visual changes, unilateral, pulsating, photophobia, phonophobia. Auras.
pain is in and around 1 eye, unilateral. lacrimation, rhinorrhea, horner's syndrome.
Temporal arteritis (giant cell)
unilateral temporal headache - usually old >50 yo. can lead to blindness
ENT exam. Flu symtoms.
Acute close-angle Glaucoma
headache, red eye, corneal clouding
Headache, jaw stiffness, chronic ear pain
causes - HIV, TB, dengue
SAH - "worst headache of my life"
new onset progressive. after trauma
Space occupying lesion
worse in the morning. progressive. vomitting
Cerebral venous thrombosis
pain 3 months ago, 3-5sec, unilateral pain on right lip when brushing teeth, radiate to right forehead, no alleviating.
Carbon monoxide poisoning
cherry red skin
o New onset?
o If patient has history of headaches. Is there any change in headache?
o Neurological deficits: Weakness, Numbness, Visual disturbances?
o Trauma to head?
o Weight loss?
o On anti-coagulants?
o On OCP?
o Any hereditary bleeding disorders?
o Jaw claudication?
o Others: Seizure? Aura? Travel history?
Frontal - gait, muscle weakness/numbness, broca aphasia
parietal - impairement tactile, read, write, calculating, identify objects, on touch, visual neglect
Temporal - memory tinitus
Occipital - visual, hallucination
Limbic - confusion, emotions
Cerebellar - ataxia, dysdiadokinesia, dysmetria
brain stem - CN Spinal cord - paresis/sensory
Vitals: fever, BP, GCS, MMSE, mental state
Full neurological exam
Check for papilledema
Meningeal - fever, headache, stiff neck, Kernig and Brudzinski signs
Palpate temporal artery for tendernous
Bloods - FBC, culture, ESR
Neuroimaging - CT, MRI
Histology - Temporal arteritis biospy