Author Question: A 65-year-old male complains of a headache that feels like a knife is cutting into his head. He also ... (Read 69 times)

Yolanda · **on:** Jun 25, 2018

A 65-year-old male complains of a headache that feels like a knife is cutting into his head. He also reports feeling right-sided scalp and facial pain and seeing double at times. He has a history of hypertension and hyperlipidemia.

His medications include beta blocker, statin drug, and an ACE inhibitor. On physical examination, you note palpable tenderness over the right side of the forehead. There are no neurological deficits. Vision is 20/20 with lenses. No weakness of extremities. CN II to XII are intact. The history corresponds to which of the following disorders?
A. Drug toxicity
B. Giant cell arteritis
C. Cluster headache
D. Migraine headache

Question 2

A 56-year-old woman brings her 78-year-old father to the emergency room. The patient complains that sometimes he can't think straight.

His daughter reports that her father has been tripping over his own feet and has become incontinent of urine in the last few days. The patient's medications include an ACE inhibitor and beta blocker. On physical examination, vital signs are within normal limits, heart and lungs show no abnormalities, cranial nerves are intact, and sensation and muscle strength are normal. A mental status exam is normal. Imbalanced gait and a positive Romberg test are apparent. Which of the following are possible disorders?
A. Cerebellar dysfunction
B. Normal pressure hydrocephalus
C. Early dementia
D. A & B

iman · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: B
Temporal arteritis is also referred to as giant cell arteritis or cranial arteritis. It is characterized by chronic inflammation and the presence of giant cells in large arteries, usually the temporal artery, but can occur in the cranial arteries, the aorta, and coronary and peripheral arteries. It affects the arteries containing elastic tissue, resulting in narrowing and eventual occlusion of the lumen. It occurs more among persons over 50 years of age and is slightly more common in females than in males. The cause is unknown, but there seems to be a genetic predisposition. If left untreated, arteritis can rapidly lead to blindness that is often irreversible. The most common chief complaint is head pain that is lancinating, sharp, or ice pick in nature. Patients often complain of visual changes, including amaurosis, diplopia, blurred vision, visual field cuts, eye pain, periorbital edema, and intermittent unilateral blindness. Other common presenting symptoms include scalp and/or jaw tenderness, facial pain, and tenderness to palpation over the affected artery. The pain is generally hemicranial but can be bilateral or diffuse. There may be eye pain, which is usually bilateral; periorbital edema may be present. Other potential associated symptoms include an intermittent fever (generally low grade), nausea, and/or weight loss.

Answer to Question 2

ANS: D
Normal pressure hydrocephalus is not fully understood. It is seen primarily in persons over 60 years of age and involves enlargement of the ventricles, often without increased CSF pressure; intraventricular pressures may be high or normal. One of the theorized causes includes intermittent pressure increases. It is slightly more common in men than in women. The patient often first notices some degree of gait disorder, followed by the onset of a clouding of thought processes, which gradually progress. The typical picture is a patient who has a triad of gait disturbance, altered thought processes, and urinary incontinence. Strength and sensation are usually within normal limits. However, focal neurological findings are present and include increased deep tendon reflexes, the inability to tandem walk, positive Babinski, and/or positive Romberg.