Wednesday, February 3, 2016

sinusitis presents with a severe headache- Dr.Sudeep K.C.

A 46-year-old woman with a history of sinusitis presents with a severe headache. She complains of
neck stiffness and photophobia. 

On physical examination , she has a temperature of 103.4°F. Blood pressure is normal and heart rate is 110/min. She has a normal funduscopic examination and no focal neurologic deficit. She has nuchal rigidity.

Brudzinski and Kernig  signs are positive.

Which of the following is the most likely diagnosis?


a. Migraine headache
b. Cluster headache
c. Torticollis
d. Bacterial meningitis
e. Cysticercosis
f. Fever of unknown origin

The answer is d.   The patient is demonstrating signs of meningeal irritation. She has nuchal rigidity,
a positive Brudzinski sign (involuntary flexion of the hips and knees when flexing the neck), and a positive Kernig sign (flexing the hip and knee when the patient is supine, then straightening out the leg, causes resistance and back pain). Other signs of meningitis include headache, photophobia, seizures, and altered mental status. Patients with meningitis (<1%) rarely have papilledema secondary to increased intracranial pressure.
Risk factors for meningitis include sinusitis, ear infection, and sick contacts. Fever of unknown origin (FUO) is defined as a fever of >101°F for 3 wk that remains undiagnosed after 1 wk of aggressive investigation.

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