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23-year-old male medical student with headache and intermittent fever for…
23-year-old male medical student with headache and intermittent fever for 2 weeks
Nature of headache
Sudden onset
Pituitary apoplexy (rare). Other Sx: impaired consciousness, visual disturbance (aura), variable ocular paresis
New onset
Immunocompromised => Intracranial infections, e.g. epidural abscess, subdural empyema. Other Sx: lethargy, nausea, vomiting, purulent drainage from nose/ear if present with sinus infections.
Frontal headache/aggravated by bending forwards => acute rhinosinusitis. Other Sx: sinus tenderness, reproducible pain on percussion of frontal and maxillary sinuses, nasal congestion, cough, sneezing, typical viral URTI slowly improving but worsen again with more severe Sx.
Increasing in frequency and severity over days
Mass lesion. Other Sx: papilledema, impaired consciousness, usually bilateral headache, could be sudden onset headache, worse in the morning/after daytime napping, may present with focal neurologic deficits
Subacute/chronic meningitis: refer to meningitis: "
Other associated signs/symptoms
".
Subsequent to head trauma
Intracranial hemorrhage. Other Sx: vomiting, decreased level of consciousness, meningismus (if there's intraventricular blood)
Other associated signs/symptoms
Impaired consciousness
Meningitis. Other Sx: neck stiffness (classic triad w fever and altered mental status), worsening headache with jolt acceleration/exertion, nausea/vomiting, trigger factors: stress/wine/weather changes, photophobia. Subset of meningococcus which may present with acute-onset non-blanchable/purpuric rash.
Encephalitis. Other Sx: altered mental status, seizures, vomiting
Focal neurological signs or symptoms
Intracranial infections. Refer to new-onset headache.
Collagen vascular disease (autoimmune). Other Sx: muscle weakness, body aches, joint pain, fatigue, skin rash
Stroke. Other Sx: sudden numbness, especially unilateral, sudden trouble walking, lack of coordination
Myalgia/Arthralgia
Dengue fever. Other Sx: vomiting, transient macular rash. Febrile phase usually lasts 3-7days.
Leptospirosis infection. Other Sx: red eye, bleeding. May present with meningitis.
Arthralgia => Rickettsia. Other Sx: rash, eschar (classic pentad but all 5 rarely present). May progress to pneumonitis/meningoencephalitis.
Acute retroviral syndrome. Other Sx: primary HIV infection may have lymphadenopathy, +/- fever, sore throat, rash/mucocutaneous ulcers, check for high-risk behaviours
Infective endocarditis (more common in men >60YO). Other Sx: chills, anorexia, weight loss, abdominal pain, malaise, dyspnea, cough