General

CaseStudy_05112016- 1

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5 Nov 2016 - General
 

A young lady with background of polycystic kidney disease, attened the emergency department because of few episodes of intermitent headache since 1 weeks ago. According to her, the first headaches that she had around 1 week ago was the worst headache that she ever had, with the severity of 10/10, start at occipital area. It lasted for around 30 miutes and improved after she took 2 tablets of paracetamol. After that , she did explained few epsiodes of intermittent headache, much less severe comparing to the first episode. There were no  photobobia, no nneck stiffness, no fever, and no other neurological symptoms. Currently, when you assess her in emergency department, her headache was fully resolved, with all normal examination. Her last headache was around 16 hours, very mild in nature. What would be your management or invesyigation plan ??

Yes Md Shamim Reza , subarachnoid haemorrhage is very unlikely in this case, given that she had the headache since 1 week ago. But given her background history of polycystic kidney disease, MRI-Brain and Angiogram should be done to rule out any possibility of cerebral aneurysm. There is high incidence of cerebral aneurysm in patients with polycystic kidney disease. Hence, we need to rule out the potential life t...
 (Total 120 words)
I think the headache of this patient is due to uncontrolled hypertension caused by PKD. Severe headache in a patient of polycystic kidney disease is an alarming sign. It may be due to sub arachnoid hemorrhage resulting from ruptured aneurysm. But the patient has no other sign of SAH, and the pain is resolved. So SAH is excluded. However presence of an aneurysm in the brain is not impossible.
An MRI of brain is required to detect any aneurysm. The status of PKD need to be reassessed too. Bec...
 (Total 130 words)