History of Present Illness: A patient in their mid-30’s and mother of 3 with a history of hypothyroidism and gestational diabetes presents to the hospital for a first-time seizure.  She was diagnosed with new onset migraine headache at an urgent care visit yesterday and started on Maxalt.  She has come around and denies fever, vomiting or any focal neurologic deficits but states her headache seems worse.

Vital Signs & Physical Exam: Vital signs are normal.  She is a bit drowsy but can give a history and follow commands.  Neurologically she is non-focal and there is no evidence of tongue biting but she is incontinent of urine.

Initial Diagnostic Testing:

  • CBC and CRP: normal
  • Chem-7 and UA: normal except for glucose of 171
  • Imaging: slice from CT brain shown below

What is the most likely diagnosis?

  • A) Hypertensive bleed
  • B) Cerebral venous thrombosis (CVT)
  • C) Brain Tumor
  • D) Subarachnoid bleed

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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QUIZ ANSWER:

  • A) Hypertensive bleed
  • B) Cerebral venous thrombosis (CVT) – CORRECT
  • C) Brain Tumor
  • D) Subarachnoid bleed

1-Minute Consult on this topic: Click HERE and scroll to page 176.

CASE CONCLUSION: Patient evaluated as stroke code by neurology.  After imaging neuro recommended standard DVT anticoagulation with heparin or LMWH.  Heparin chosen due to reversability.  Pharmacy consulted and recommended standard dosing.  Admitted to ICU and Hospital team felt hormone replacement was likely cause,  COVID IgG added to look for other potential precipitant.

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