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What's the take home?

A 43-Year-Old Man With New Headaches

Ronald N. Rubin, MD1,2 —Series Editor

Volume 62 - Issue 10 - October 2022

  • AFFILIATIONS:
    1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
    2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania

    CITATION:
    Rubin RN. A 43-year-old man with new headaches. Consultant. 2022;62(10):e38-e41. doi:10.25270/con.2022.09.000002

    DISCLOSURES:
    The author reports no relevant financial relationships.

    CORRESPONDENCE:
    Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 (blooddocrnr@yahoo.com)

     

    A 43-year-old man presents after experiencing 2 days of an unusual headache. On each of the previous 2 days, he first noted blurry vision accompanied by flashes of light in the left eye, which expanded for roughly 30 minutes and were followed by a throbbing left-sided headache. The visual symptoms abated, but the headache remained. He took 400 mg of ibuprofen, which yielded significant but not complete pain relief. He was slightly nauseated, but there was no emesis. There were no further ocular or neurologic symptoms. By the evening of day 2, he was feeling better and slept through the night without pain. He awoke the next morning feeling well but later in the day experienced symptoms again, which prompted him to present to the clinic.

    History. He is an otherwise healthy man with no other major medical diagnoses by history. He exercises regularly. His only medications are occasional ibuprofen for minor orthopedic issues. No history of falls or head trauma is noted.

    Physical examination. Testing revealed vital signs within normal limits. Specifically, the patient was afebrile and normotensive. Results of a head, eyes, ears, nose and throat examination showed his pupils were equal, round, reactive to light and accommodation and had full and normal extraocular movement. A fundoscopy performed in the office was negative for obvious retinal hemorrhage, and vision in both eyes seemed normal.

    A neurological examination revealed intact cranial nerves II through XII with no focal or lateralizing signs. Routine blood studies (eg, complete blood cell count, basic and comprehensive metabolic panels) were all within normal limits.

     

    Answer and discussion on next page.