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MORE THAN JUST A HEADACHE : A CASE PRESENTATION

MORE THAN JUST A HEADACHE : A CASE PRESENTATION. By: Dr. Aqeela Rasheed PGR Medical Unit-IV. Patient Profile. Patient XYZ Age/sex 23 years/female D.O.A 5.10.2012 M.O.A. Emergency.

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MORE THAN JUST A HEADACHE : A CASE PRESENTATION

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  1. MORE THAN JUST A HEADACHE : A CASE PRESENTATION By: Dr. Aqeela Rasheed PGR Medical Unit-IV

  2. Patient Profile Patient XYZ Age/sex 23 years/female D.O.A 5.10.2012 M.O.A. Emergency

  3. Presenting Complaint C/O Headache 5 days Fever 2 days Fits 1 day Unconsciousness 1 day

  4. History Of Present Illness • Normal delivery (♂) - 8 days back • at local hospital in Okara • Baby - healthy & delivery - uneventful • Discharged on the same day

  5. History (contd…) • HEADACHE Gradual, Moderate, continuous, Diffuse (R > L), Dull, No aggravating/relieving factor, Vomiting, Neck pain & photophobia • FEVER Gradual, ↓grade, Continuous, no rigors /chills & Relieved by medicine temporarily

  6. History (contd…) • FITS Recurrent, tonic clonic, Focal on Lt. side of body, later became Generalized, Urinary Incontinence & tongue bite • Altered state of consciousness

  7. Systemic Inquiry • H/o Rt. ear discharge - 1 year • No other significant history Past History • Not significant Allergic History • No known drug allergies

  8. Family History • No significant family history Treatment History • Not significant Socioeconomic History • Poor socioeconomic status

  9. Personal History • House wife • Normal sleep and bowel habits • Non-smoker, non addict Gynecological History • Married for 3 years • P2 A0 • Both children are alive and healthy

  10. EXAMINATION

  11. General Physical Examination A woman of average physique lying in bed, unconscious, with an I.V. line secured, NGT & Foley`s are in situ: • BP: 130/70 mmHg • Pulse: 105/min • Temperature: 100°F • R/R: 18/min

  12. CNS Examination • GCS • 5/15 (E 1,V 1, M 3) • Cranialnerves • Pupils equal & reactive to light b/l • Fundoscopy • Bilateral papillaedema • NeckStiffness ++

  13. CNS Examination

  14. Ear Examination • Rightearcanal • Mild congestion &minimal debris • no defect and ulceration • No ear discharge • Leftearnormal • mastoidareas • No swelling & tenderness Systemic examination • Unremarkable

  15. DIFFERENTIALDIAGNOSIS

  16. Differential Diagnosis • Meningo-encephalitis • Brain abscess • Cerebral malaria • Cerebral venous thrombosis • SAH • Ecclampsia • Puerperal sepsis

  17. INVESTIGATIONS

  18. Investigations

  19. Investigations

  20. USG Abdomen Pelvis Normal scan CXR Normal

  21. CT Scan Brain (Plain)

  22. CT Scan Brain (Plain)

  23. CT Scan Brain (Plain)

  24. Magnetic Resonance Venography

  25. C T Scan Mastoid Lt. Rt. Rt . Lt.

  26. Final Diagnosis CEREBRALVENOUS THROMBOSIS (Transverse And Sigmoid Sinuses) Predisposingfactors • Puerperium • Rt. Mastoiditis

  27. Management • TO TREAT INFECTION • Antibiotics (Vancomycin, Pipericillin + Tazobactam) • ANTICOAGULATION • Heparin followed by warfarin • TO CONTROL RAISED ICP • Dexamethasone and mannitol

  28. Management • CONTROLSEIZURES • Antiepileptics (Na valproate) • I.VFLUIDS • 0.9℅ normal saline

  29. Management • Neurosurgical consultation • ENT evaluation

  30. Course Of Disease

  31. CEREBRAL VENOUS THROMBOSIS

  32. Venous Sinus Thrombosis on MRV 17 % 62% 11% 18% 41-45% 12%

  33. Epidemiology • Female to male ratio 3:1 • Common in neonates and children • Overall incidence <1/100,000 annually

  34. Pathogenesis • Cerebral parenchymal lesions or dysfunction • Decreased CSF absorption and raised intra cranial pressure

  35. Etiology • Prothrombotic conditions, genetic or acquired • Oral contraceptives • Pregnancy and the puerperium • Head and Neck Infection • Malignancy • Head injury & mechanical precipitants

  36. Clinical Features • Isolated intracranial hypertension syndrome • Focal syndrome • Encephalopathy

  37. Dense Triangle Sign

  38. Cord Sign

  39. Empty Delta Sign

  40. Venous Hemorrhage

  41. Take Home Message • Uncommon but serious neurologic disorder. • Imaging plays a primary role in diagnosis. • Potentially reversible.

  42. T H A N K S

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