Case 8: 47 year old male with sudden onset of headache
Written by: Ahmed Tarig Ahmed, MD, Resident, Internal Medicine, Cook County Hospital, Chicago, IL,USA Reviewed by: Abdelazim Sirelkhatim, MBBS, DABPN, Assistant Professor, University of Tennessee, Chattanooga, TN, USA Associate director, Erlanger Stroke center, Chattanooga, TN, USA Amin Elkhatim Elyas MBBS, MRCS, Clinical Fellow in Neurosurgery, Southampton University Hospital, Southampton, UKCase Description
History
A 47 years old male presents to the emergency room with sudden onset of bilateral frontal throbbing headache. He said it was the worst headache in his life, non radiating, with no other associated symptoms, specifically no syncope, blurred vision, neck pain, fever or vomiting. It started 3 days prior to presentation, and had awakened him from sleep. He denies any previous history of headaches. He has no cough or nasal congestion. He took Ibuprofen without relief so came to the hospital.
Past medical History: none
Social history: smokes 1 pack per day
Drug history: No long-term medication, no known drug allergies
Physical Examination:
Temperature 38 degrees celsius, Blood pressure 140/94, heart rate 80/min, oxygen saturation 99% on room air
He was lying flat in bed, comfortable, not in distress, alert and oriented to time, place and person
No photophobia
Neck: mild neck stiffness, no Lymphadenopathy
Chest clear no added sounds
Heart: Normal heart sounds, no murmurs
Abdomen: soft non tender
Lower Extremities no edema, pulses intact
Neurological examination:
Normal Cranial Nerves, Negative Kernig’s sign, Negative Brudinski sign
Normal tone, power, reflexes, coordination, sensation in all 4 limbs
Normal gait, normal plantar reponse, negative Romberg’s sign
Laboratory Results:
CBC (complete blood count), BMP (basic metabolic panel inclues Na, K, BUN, Cr, Cl, HCO3), ECG were all within normal limits