Minicases Flashcards
21 F, Headache
- Episodes of throbbing L temporal pain, 2-3 hrs, nausea/vomiting
- Flashes of light (aura) @R + weakness/numbness @R, few min before
- FMHx migraine
DDx: Migraine, tension headache, cluster headache, Pseudotumor celebri, Trigeminal neuralgia, CNS vasculitis, Partial seizure, Intracranial neoplasm
Work up: CBC, ESR, CT-head, MRI-brain, LP (if CT neg)
26 M, Headache
- Severe R temporal headache for 45min
- Ipsilateral rhinorrhea, tearing, redness
- Episodes at the same time every night, 1 wk
DDx: Cluster headache, migraine, tension headache, sinusitis, Pseudomotor celebri, Trigeminal neuralgia, intracranial neoplasm
Work up: CBC, CT-head, MRI-brain, LP, ESR
65 F, Headache
- Severe intermittent R temporal headache
- Fever, blurred vision R eye, pain in jaw when chewing (claudication)
DDx: Temporal arteritis, migraine, cluster or tension headache, Meningitis, carotid aa dissection, temporomandibular joint disorder, Pseudotumor celebri, Trigeminal neuralgia, intracranial neoplasm
Work up: CBC, ESR, CRP, temporal aa biopsy, Doppler U/S carotid, MRI-brain, LP
30 F, Headache
- Frontal headache, fever, nasal discharge
- Pain on palpating of maxillary/frontal sinuses
- Hx of allergy
DDx: Sinusitis, migraine, tension headache, Meningitis, intracranial neoplasm
Work up: CBC, XR-sinus, CT-sinus, LP
50 F, Headache
- Bilateral squeezing headache 3-4x/wk, end of work day
- Significant stress in life
DDx: Tension headache, migraine, cluster headache, HTN, Depression, caffeine/analgesic withdrawal, Pseudomotor celebri, intracranial neoplasm
Work up: CBC, electrolytes, ESR, CT-head, LP
35 M, Headache
- Sudden severe headache
- vomiting, confusion, L hemiplegia, nuchal rigidity
DDx: Subarachnoid hemorrhage, intracranial hemorrhage, meningitis, encephalitis, vertebral aa dissection, intracranial VT, Acute HTN, intracranial neoplasm
Work up: Noncontrast CT-head, CBC, LP, PT/PTT/INR
25 M, Headache
- High fever
- Severe headache, confusion, photophobia, nuchal rigidity
- Kernig and Brudzinsky signs +
DDx: Meningitis (viral, bacterial), migraine, subarachnoid hemorrhage, encephalitis, sinusitis, intracranial/epidural abscess
Work up: CBC, CT-head, MRI-brain, LP-CSF analysis (cell count, protein, glucose, gram stain, PCR of antigens, culture)
18 F, Headache
- Pulsatile headache (esp post ocular) and tinnitus, vomiting, blurred vision 3/52
- Obese, Taking OCP
DDx: Pseudomotor cerebri (idiopathic intracranial HTN), tension headache, migraine, cluster headache, meningitis, intracranial VT, intracranial neoplasm
Work up: Urine hCG, CBC, CT-head, LP- opening pressure, CSF analysis
57 M, Headache
- Daily pain @ R cheek, 1/52
- Pain electric/stabbing, occurs while shaving, 2-4 min
DDx: Trigeminal neuralgia, tension headache, migraine, cluster headache, TMJ dysfunction, intracranial neoplasm
Work up: CBC, ESR, MRI-brain
81 M, Confusion, memory loss
- Progressive confusion, clumsiness, forgetfulness for few years
- PMHx: HTN, DM, 2 strokes + residual L hemiparesis
- Declining mental status after each stroke
DDx: vascular (multi-infarct) dementia, Alzheimer’s D, normal pressure hydrocephalus, Chronic subdural hematoma, intracranial neoplasm, depression, B12 deficiency, neurosyphilis, hypothyroidism
Work up: CBC, VDRL/RPR, serum B12, TSH, MRI-brain, CT-head, LP-CSF analysis
84 F, Confusion, memory loss
- Progressive Forgetfulness (phone number, direction), few yrs
- Difficulty with ADLs and IADLs
DDx: Alzheimer’s D, vascular dementia, depression, hypothyroidism, chronic subdural hematoma, normal pressure hydrocephalus, intracranial neoplasia, B12 deficiency, neurosyphilis
Work up: CBC, VDRL/RPR, serum B12, TSH, MRI-brain > CT-head, LP-CSF (rare)
72 M, Confusion, memory loss
- Memory loss, gait disturbance, urinary incontinence, 6/12
DDx: Normal pressure hydrocephalus (triad), Alzheimer’s D, vascular dementia, chronic subdural hematoma, intracranial neoplasm, depression, B12 deficiency, neurosyphilis, hypothyroidism
Work up: CT-head, LP- opening pressure and CSF analysis, VDRL/RPR, serum B12, TSH,
55 M, Confusion, memory loss
- Rapid mental status decline
- Inability to concentrate, memory impairment, 2/12
- Assoc w myoclonus, ataxia
DDx: Creutzfeldt-Jakob D (CJD), vascular dementia, Lewy body dementia, Wernicke encephalopathy, normal pressure hydrocephalus, chronic subdural hematoma, intracranial neoplasm, depression, delirium, B12 deficiency, neurosyphilis
Work up: CBC, electrolyte, calcium, serum B12, VDRL/RPR, MRI-brain > CT-head, EEG, LP- CSF analysis, brain biopsy
70 M, Confusion, memory loss
- Insulin dependent DM
- Episode of confusion, dizziness, palpitation, diaphoresis, weakness
DDx: Hypoglycemia, transient ischemic attack, arrhythmia, delirium, angina
Work up: Glucose, CBC, electrolytes, echocardiography, ECG, MRI- brain, doppler U/S- carotid
55 F, Confusion, memory loss
- Gradual altered mental status and headache
- head trauma associated w 2 min LOC after a fall 2 wks ago
DDx: Subdural hematoma, SIADH (hyponatremia), Creutzfeldt-Jakob disease, Intracranial neoplasm
Work up: Electrolytes, CT-head, MRI-brain, LP (14-3-3)
