History of Present Illness:

A 30-ish-year-old male with a history of headaches but no migraine presents with 1 day of bitemporal headache and vomiting and photophobia without fever.  HA has been gradually worsening since yesterday.  He had 2 similar headaches in his life. He denies any weakness numbness or change in vision but has had a little bit of cough sore throat chills but no fever and photophobia.

Vital Signs & Physical Exam:

Vital signs are normal except for elevated BP.  Physical exam is also normal except for a positive jolt sign and the finding below

What is the most likely diagnosis?

  • A) Migraine
  • B) Meningitis
  • C) Monoxide
  • D) Mass

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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QUIZ ANSWER: What is the most likely diagnosis?

  • A) Migraine – can cause photophobia, but typically not this severe
  • B) Meningitis – CORRECT.  In a patient with symptoms concerning for meningitis if the photophobia is severe enough that they want to keep a blanket over their head and or their eyes closed most of the time, strongly consider an LP
  • C) Monoxide
  • D) Mass

1-Minute Consult on this topic: Click HERE and scroll.

 

CASE CONCLUSION: CSF had normal protein and glucose but 40 WBC and 160 RBC.  Culture and CSF panel eventually came back negative (included HSV1, HSV2, VZV and others)