Case
A 35-year-old female presents to the emergency department with a chief complaint of headache. She has a past medical history significant for depression, migraines, and seasonal allergies. One week ago, she delivered a healthy newborn by vaginal delivery without any complications and went home the next day. In the past week, she had a series of severe headaches which she tried sumatriptan with incomplete relief. This most recent headache started immediately after sneezing. She notes she has been suffering from “hayfever” and has been taking loratadine/pseudoephedrine. She also takes escitalopram regularly.
Vital signs are normal except for HR 105/min and BP 135/80 mm Hg. The exam is limited due to pain, but she is uncomfortable appearing and clutching her head. However, you are unable to find any focal neurologic deficits.
What is the diagnosis? You can ask for additional information if needed.
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Robby
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4 Comments
Shane Solger · June 25, 2021 at 10:44 pm
RCVS
Citation:
Allen, R., 2021. “Reversible Cerebral Vasoconstriction Syndrome Morning Report”.
Shane Solger · June 26, 2021 at 7:28 am
1. Sattar A, Manousakis G, Jensen M. Systematic review of reversible cerebral vasoconstriction syndrome. Expert Rev Cardiovasc Ther. 2010;8(10):1417-1421. doi:10.1586/erc.10.124
T Bone · June 26, 2021 at 10:10 am
Pituitary apoplexy also on the dDx although I too like RCVS for this.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442203/pdf/bcr-2015-210198.pdf
Harry · June 26, 2021 at 10:26 pm
Cerebral venous thrombosis