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HA & Diplopia

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A woman in her early 20’s presents to the ED for 3 days of gradually worsening severe left frontal headache followed by 24 hours of diplopia worse looking to the left and one episode of vomiting earlier today.  She doesn’t want any strong pain medicine that might affect her 8 month old who is breast feeding.

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is normal except for EOM.  See image below of patient looking to her left.

Initial Differential Diagnosis:

  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • EKG: none
  • Labs: none ordered
  • Imaging: Head CT, CTA and CTV were normal

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows .
  2. What should you do next?  Treat with.  Consult.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

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

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CASE CONCLUSION: We’ll just have to see

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