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
<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>
***************************************************************************
THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
Get one of our publications, all designed specifically for Emergency Care Providers:
- Tarascon Emergency Department Quick Reference Guide, 2nd edition
- Emergency Medicine 1-Minute Consult Pocketbook, 5th edition (NEW)
- A to Z pocket EM Pharmacopoeia, 4th ed (NEW)
***************************************************************************
<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>
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
CLICK HERE TO LEAR MORE ABOUT THIS BOOK
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:
- “Are you on any medications?” (I love when this elicits multiple meds after the patient just denied any PMH)
- “Have you started, stopped or changed doses of any medications recently?”