Your Cart ()
cload

GUARANTEED SAFE & SECURE CHECKOUT

Spend $99.99 to Unlock Free Shipping within CONUS.

SAEM Clinical Image Series: Young Woman with a Headache

By Walter L Green, MD September 02, 2019 0 comments

Headache

[Click for larger view]
Chief complaint: Headaches for 1 year

History of Present Illness: A 31-year-old woman with no significant past history presents with a dull headache.

She notes the headache is generalized, has been almost daily for a year and is worsened by bending over. She denies nausea, vomiting, photophobia, trauma, seizures, focal weakness, numbness, or vision change. Acetaminophen and ibuprofen provide only mild, short-acting relief. She takes oral birth control and her periods have been normal.


Vitals: Height 5’ 7”, Weight is 223 lbs (101 kg), otherwise unremarkable.

Eyes:

  • Pupils are 3 mm and reactive, extraocular movements are normal and there is no injection.
  • Visual fields are intact to finger counting and visual acuity is 20/30 bilaterally.
  • Examination of the fundus is revealed in the photo.

Neurologic: Gait is normal and there are no focal deficits.

CBC: Normal

BMP: Normal

D-Dimer: Negative

Idiopathic intracranial hypertension

This is a classic presentation of idiopathic intracranial hypertension (IIH).

It is mainly diagnosed in young obese women; predisposing factors include oral contraceptives, anabolic steroids, tetracycline, and vitamin A. The pathophysiology is not known, but may be due to an imbalance of CSF production and absorption. CSF pressure is greater than 200–250 mm H20.

Papilledema is present, and visual field defects and blindness can occur with progression of the disease. Neuroimaging is required to rule out other causes of intracranial hypertension including intracranial masses, obstruction of CSF flow, and venous sinus thrombosis. A negative D-Dimer can help evaluate for venous sinus thrombosis in low-risk patients, although venous phase imaging with MRI is more sensitive and specific.

Evidence-based treatment of IIH is lacking. Acetazolamide has been used to decrease CSF production, but emergent referral for ventricular shunting or optic nerve sheath fenestration is indicated if visual loss is present. The retinal image was taken at the bedside using a Panoptic™ attached to a smartphone camera.

Take Home Points

  • Papilledema is a sign of intracranial hypertension and may be caused by intracranial masses, obstruction of CSF flow, or idiopathic intracranial hypertension.
  • Idiopathic intracranial hypertension is typically seen in young, obese women.
  • Predisposing factors include oral contraceptives, anabolic steroids, tetracycline, and vitamin A.

Author information

Walter L Green, MD

Walter L Green, MD

Assistant Program Director; Chief, Billing & Coding
Associate Professor, Dept of Emergency Medicine
University of Texas Southwestern/Parkland Hospital, Dallas, Texas

The post SAEM Clinical Image Series: Young Woman with a Headache appeared first on ALiEM.


Older Post Newer Post

Newsletter

I agree to subscribe to updates from Shoptimized™

Categories

B. Dupont Purchased 1 minute ago from Los Angeles, CA
2
C. Santos Purchased 1 minute ago from Chicago, IL
5.11 FLEX TacMed Pouch
D. Kim Purchased 1 minute ago from Houston, TX
5.11 FLEX Tourniquet Pouch
E. García Purchased 2 minutes ago from Phoenix, AZ
5.11 UCR TacReady Headrest Pouch
F. Müller Purchased 1 minute ago from Philadelphia, PA
Abdominal Aortic and Junctional Tourniquet-Stabilized (AAJT-S)
G. Rossi Purchased 2 minutes ago from San Antonio, TX
Adjustable Flange Nasopharyngeal Airway
H. Martinez Purchased 1 minute ago from San Diego, CA
Adult Bag Valve Mask
J. López Purchased 2 minutes ago from Dallas, TX
Altama OTB Maritime Assault Boot - Low Height
K. Nowak Purchased 1 minute ago from San Jose, CA
Altama OTB Maritime Assault Boot - Mid Height
L. Müller Purchased 2 minutes ago from Austin, TX
AMBU Perfit ACE Adjustable Cervical Extrication Collar
M. Ivanova Purchased 2 minutes ago from Jacksonville, FL
Amphibious Trauma Kit
N. Andersen Purchased 2 minutes ago from Fort Worth, TX
Army CLS Resupply Kit (CLS™)
O. Fischer Purchased 2 minutes ago from Columbus, OH
Backpack Accessory Pouch Kit - 4 Color
P. Bernard Purchased 1 minute ago from Charlotte, NC
Ballistic Soft Panel for Plate Carrier
S. Schmidt Purchased 2 minutes ago from San Francisco, CA
Bandage Fill Kit
T. Kowalski Purchased 1 minute ago from Indianapolis, IN
Bandage Shears
X. Martinez Purchased 1 minute ago from Seattle, WA
Bard-Parker Safety Scalpel #10
Y. Ahmed Purchased 2 minutes ago from Denver, CO
Basic Field Surgical Airway Kit w/ET Tube
Z. Khan Purchased 1 minute ago from Washington, DC
Beacon Chest Seal - Occlusive/Non-Vented
A. Ali Purchased 1 minute ago from Boston, MA