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25 year-old obese woman develops headache and diplopia. Headache is throbbing,
last two hours and resolves; headache is made worse by vomiting and coughing.
Diplopia is most marked on far gaze and disappears when one eye is closed.
She has no other neurological symptoms.
FH-positive for migraine
PMH - acne, obesity, amenorrhea
Neuro exam:
left lateral rectus paresis
fundi - no spontaneous venous pulsations; disc margins appear blurred
but no hemorrhage or exudates are seen
nl - visual fields, reflexes, gait, motor
VA - 20/20 bilaterally
pupils-equal in size and
reaction to light
Images
- Based upon the clinical
history and exam. What is the most likely diagnosis?
- CT and MRI are unavailable
for 48 hours; can LP be done without these procedures?
- While waiting for diagnostic
studies, she receives Demerol and Phenergan for headache.
She becomes obtunded with agonal
respirations. CT is now done. What does it show? What has happened to this
patient?
- Could
this patient have an intracranial neoplasm, hydrocephalus or meningitis.
- Is magnetic resonance angiogram
or venogram warranted, and if so what are you looking for?
- Discuss this premise -
the disorder pseudotumor cerebri (benign intracranial hypertension,
idiopathic intracranial hypertension is a Tulane disease as more Tulane
faculty and former students have contributed to the literature (Ruth
Patterson, Leon Weisberg, Michael Wall, Deborah Friedman). I guess this
means that you go to the library and review the medical literature starting
with two journals Medicine and Brain.
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