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Post-Partum Headache

History of Present Illness:

A woman in her 20’s presents to the ER for 10 days of generalized severe headache, nausea and intermittent vertigo lasting only seconds.  She is 2 months post partum.  She denies any fever, vomiting, abdominal pain, focal CNS complaints or other concerns.

Vital Signs & Physical Exam:

Vital signs are normal.   Physical exam is normal including FNF, Romberg, cranial nerves and gait.

Initial Diagnostic Testing:

  • CBC: normal
  • Chem 7: normal
  • Imaging: an MRI is done

What is the most likely diagnosis?

  • A) Venous sinus thrombosis
  • B) Vertebral artery dissection
  • C) SSRI withdrawal
  • D) Encephalitis

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWER:

  • A) Venous sinus thrombosis: The image is of the MR venogram and was read as good quality and normal
  • B) Vertebral artery dissection: symptoms are not concerning for this condition
  • C) SSRI withdrawal: CORRECT.  On further questioning patient confessed to running out of her SSRI a few days before her symptoms started.
  • D) Encephalitis: symptoms are not concerning for this condition

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: Patient was restarted on her SSRI and told to follow up with her doctor

CASE LESSONS: Always consider medications or their withdrawal as a cause of otherwise unexplained symptoms.  Great questions to ask during the initial history include:

  1. “Are  you on any medications?” (I love when this elicits multiple meds after the patient just denied any PMH)
  2. “Have you started, stopped or changed doses of any medications recently?”
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