A 32-year-old woman with a history of epilepsy presents to the Outpatient Clinic seeking advice on starting the oral contraceptive pill. She has been taking carbamazepine as her sole anti-epileptic medication for the past four years and has been seizure-free for the last 18 months on her current dose. What is the optimal approach to managing her situation?
A 38-year-old woman presents with a gradual onset headache and 5 days of drowsiness. The headache started in the occipital region and has been radiating to the apex. She recently returned from a holiday in Australia one week ago and has been experiencing poor appetite after a cough and cold since then. She has no medical history, takes only the oral contraceptive pill, and is a non-smoker who drinks minimally. On examination, she has a full range of neck movements and no photophobia. Her limb examination is unremarkable. A CT head without contrast reveals two small areas of subarachnoid blood in the right convexity. She denies any recent head trauma. What investigation is most likely to provide a conclusive diagnosis?
A 68-year-old woman visits her doctor complaining of palpitations. Upon examination, she is diagnosed with atrial fibrillation and has a medical history of hypertension and is currently taking bendroflumethiazide. The doctor wants to inform her about her risk of stroke associated with atrial fibrillation. What is her yearly risk of stroke?
A 35-year-old mother of two is brought to the Emergency Department by her husband. She has been experiencing severe sore throat over the past few days, and has deteriorated on the morning of admission complaining of severe neck stiffness and a headache. She has no past medical history of note; her only medication is the combined oral contraceptive pill.
On examination, she is pyrexial at 38.9 °C. Her blood pressure is 90/50 mmHg and her pulse is 105 bpm and regular. Her Glasgow Coma Scale (GCS) score is 13, she has obvious meningism, and you notice a generalised purpuric rash.
Investigations:
Haemoglobin (Hb) 110 g/l 120–160 g/l
White cell count (WCC) 18.5 × 109/l 4–11 × 109/l
Platelets (PLT) 200 × 109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 3.8 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 80 µmol/l 50–120 µmol/l
C-reactive protein (CRP) 250 mg/l 0–10 mg/l
Glucose 6.5 mmol/l 3.9–7.1 mmol/l
What is the most appropriate next step?
A 28-year-old woman presented with a 4-month history of feeling down and a sensation of being followed by people wherever she goes. She has no previous medical history and is not taking any prescription medication, but she admits to occasionally using marijuana since her teenage years and more frequently in the past 4 months. The onset of her symptoms coincided with the death of her mother from cancer 8 months ago.
During the neurological examination, she exhibited occasional facial grimacing and twisting movements of her limbs. Her tone, strength, and reflexes were all within normal limits. Cranial nerve assessment was unremarkable, except for slow saccadic eye movements and difficulty maintaining tongue protrusion.
What is the most effective method to confirm the probable diagnosis?
A 28-year-old woman is referred to the Migraine Clinic. She was diagnosed with simple migraine 2 years ago.
In the last 12 months, attacks have increased in frequency and changed in nature. She now experiences a daily headache that ‘squeezes’ her forehead. The pain worsens as the day goes on. There is no correlation with movement or posture, and no other neurological symptoms are present. The pain is so severe that she has significantly increased her use of painkillers. At the time of the appointment, she is taking daily ibuprofen, aspirin, and codeine.
During the examination, her blood pressure is 130/80 mmHg, with a pulse of 75 bpm and regular rhythm. There are no notable findings on the neurological examination.
What is the most appropriate course of action?
A 40-year-old accountant presents with complaints of severe unilateral orbital and temporal headaches lasting around five minutes each and happening 15-25 times a day. The headaches have been occurring daily for over a year with no relief. The pain is described as constant and dull. Additionally, the patient experiences mild nasal congestion and increased tearing during these episodes. What is the preferred treatment for this patient?
A 52-year-old man presents to the acute medical intake with a two-week history of severe pain around his right eye. The pain began without any apparent cause and woke him from his sleep. He describes the pain as severe and boring, radiating upwards over the right frontal and temporal region. The pain is not constant but seems to start every evening and persist for periods of 20 minutes to over an hour. The headaches are associated with watering of his right eye and a blocked left nostril. He has no past history of similar episodes or any other significant medical history.
Upon examination, he is alert and oriented with a Glasgow coma scale score of 15/15. His blood pressure is 125/75 mmHg, and he is afebrile with no neck stiffness. The right eye is red with conjunctival injection and mild eyelid edema. There is a partial right-sided ptosis and miosis.
Which therapeutic option is most likely to alleviate his symptoms?
A 31-year-old male presents with his 4th episode of worst ever headache in one week. He describes the headache to always be of sudden onset on the left side of his head, of 10 out of 10 severity and that he finds bright lights extremely distressing during these periods. The episodes last for around 30 minutes, typically after dinner. He also describes redness and swelling of his left eye and a blocked left nostril during the headaches, associated with tearing of his left eye.
He has no past medical history and family history of migraines. He denies illicit drug use, is a non-smoker and drinks two glasses of wine with dinner every night. Over the past 7 days, he has been self-medicating with paracetamol and ibuprofen. On examination, you notice no focal neurology, no meningism and fundoscopy is unremarkable.
What is the most likely diagnosis?
You are working in a neurology outpatient clinic seeing a patient referred from a local GP clinic. She’s a 38-year-old woman who has been troubled by severe headaches over the past half a year. These headaches are the worse that she’s ever had in her life, describing them as far worse that the compound fracture she sustained four years ago. These headaches tend to happen most nights at around 2am just after she falls asleep. She often paces around her kitchen for a couple of hours and often resorts to bashing her head against the fridge the pain is so bad. When probed further she mentioned that she gets a sense of fullness in her right ear (which is the side that the headache most often occurs on). She remembers having a similar problem a couple of years ago that lasted a few months before resolving on their own.
What medication is most likely to prevent these headaches?