Headache Case Studies Five & Six

Case Study Five

Mark is a 50 year old roofer who has had a significant headache that has fluctuated but increased in severity over the past 3-4 weeks. He does not usually get headaches.
Last night he was woken from sleep by a headache and he vomited before he could make it to the toilet. 

 

He has felt that his balance was not as good in the past week while roofing and a couple of times, the grip on his left hand has felt weaker. 

 

That morning his left hand began twitching uncontrollably for about 10 minutes but it then settled spontaneously. 

 

On examination, his BP is 165/95, pulse 85 and regular. There is some definite weakness of grip in the left hand. ​

 

Fundi suggests mild papilloedema bilaterally.

Case Study Six

A 78 year old male with known atrial fibrillation presents with a headache. It has been present for about 2-3 weeks and is only moderate in intensity. He has not been performing up to his usual standard in past weeks and has felt a bit dizzy. He has had a number of falls lately but the worst one was 3 weeks ago when he was going to the toilet at night and tripped over something, hitting his head on the dressing table at the time. There was no loss of consciousness. He was able to go straight back to sleep after urination. 

 

His medications include ramipril, digoxin and warfarin. His INR is 2.7 

 

BP is 140/78, pulse 70 in AF ​

 

Neurological examination is normal