HPI
A 17-year-old male who is a weightlifter and wrestler comes to your clinic complaining of a 3-day history of head and mild right-sided weakness. He admits to using anabolic steroids within the past 3 months. He had a wrestling match 4 days before and had been training hard and also was trying to get his weight down to fit within his weight class for the match. He describes his headache as continuous and diffuse with a pulsatile component that can wax and wane. There have been episodes where his peripheral vision bilaterally dimmed, and one occasion where he lost vision for 2 minutes.
PMH
Unremarkable except as noted in HPI
PE
- General Exam: T 37.5oC, BP 120/58, Pulse 88 and Respirations 12.
- The rest of the general physical exam is unremarkable.
NEURO
- MS: Normal
- CN: The fundoscopic examination demonstrates superior, inferior, and lateral blurring of the disk margins bilaterally and increased caliber of the retinal veins.
- MOTOR: Mild right hemiparesis involving the leg and possibly the arm.
- The rest of the neurological exam is unremarkable.
You order an urgent CT of the head that is reported as being normal.
Study Questions:
- What other parts of your physical exam are especially important for headache patients?
- What parts of your neurological exam are particularly important for headache patients?
- Why will you always check the fundi of all headache patients?
- What pathophysiological processes could cause headache?
- What pathophysiological processes could cause the headache to be pulsatile?
- Since the CT of the head is normal can he go home? If not why not?
- What type of study would you obtain next? Why?
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