History of Present Illness: A patient in their mid-40’s and mother of 2 with no known PMH presents to the hospital for a seizure. She was diagnosed with possible cluster headache by a telemedicine appointment 2 days ago and started on sumitriptan. She denies fever, vomiting or focal neurologic deficits.
Vital Signs & Physical Exam: Vital signs are normal. She is a bit post ictal but non-focal on neuro exam. There is evidence of tongue biting.
Initial Diagnostic Testing:
- CBC and CRP: normal
- Chem-7 and UA: normal
- Imaging: CT brain and CT angio brain shown below
What is the most likely diagnosis?
- A) Hypertensive bleed
- B) Cerebral venous thrombosis (CVT)
- C) Brain Tumor
- D) Subarachnoid bleed
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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- Emergency Medicine 1-Minute Consult, 5th edition
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QUIZ ANSWER:
- A) Hypertensive bleed
- B) Cerebral venous thrombosis (CVT) – CORRECT
- C) Brain Tumor
- D) Subarachnoid bleed
1-Minute Consult on this topic: Click HERE and scroll to page 176.
CASE CONCLUSION: Patient evaluated as stroke code by neurology. After imaging neuro recommended standard DVT anticoagulation with heparin or LMWH. Heparin chosen due to reversability. Pharmacy consulted and recommended standard dosing. Admitted to ICU and Hospital team felt hormone replacement was likely cause, COVID IgG added to look for other potential precipitant.
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