Tuesday Case Study 26072016

Created by:

26 Jul 2016 - General

Middle aged woman, with background history of type 2 diabetes mellitus, hypertension, increased body mass index, was admitted due to 1 day history of severe headache of the left side. There was a gradual on-set of left sided headache in the morning, occured intermittently, became worsening to around 8-9 out of 10, towards the evening time. There was an query/possible epsiode of transiet left sided weakness in the morning. There were no neck stiffness, no photophobia, no chest or unrinary symptoms, no visual symptoms, On admission, she did has 1 occasion of spike of temperature to around 38 celcius. Cardiovascular, respiratory, neurology and abdominal examnaiton was normal. Normal chest x ray, and urine dipstick. What are your approach of investigation and management ?

@Ziwei Xie, subarachnoid haemorrhage can be a consideration, but patient did not present with the classical symptom of sudden onset, worst ever thunder clap headache. The headache is more like gradual in on-set and becoming worse. To find out whether this patient has any history of migraine will great information and patient can have hemiplegic migraine, with the transient left side weakness. In view of patient did had a spike of temperature, with mildly elevated CRP, the working diagnosis is po...
 (Total 109 words)
Urgent non-contrast CT scan in view of likelihood of subarachnoid haemorrhoid. For nontraumatic (or spontaneous) hemorrhage, it usually occurs in the setting of a ruptured cerebral aneurysm or arteriovenous malformation (AVM). CT angiography of the brain. After the diagnosis is established, further imaging should be performed to characterize the source of the hemorrhage. Laboratory studies should include the following: Serum chemistry panel.
Complete blood count, Prothrombin time (PT)/acti...
 (Total 149 words)