Sudden Headache and Vomiting in a 33-Year-Old Woman

Roshen Mathew, MBBS; Mathew Abraham, MD, DM

Disclosures

September 12, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 33-year-old woman presents to the emergency department with a severe headache that started suddenly 6 hours earlier. She states that it is the worst headache of her life, that she does not usually get headaches, and that the pain has been worsening despite her use of oral analgesic medication (namely, acetaminophen). She has had associated vomiting, both at home and since arrival at the emergency department.

Her headache is associated with mild blurred vision and weakness in her left leg that started about an hour ago. She denies having any fever, loose stools, seizures, or other visual symptoms (such as floaters, fortification, or loss in visual acuity).

Her medical history is unremarkable, with no hospitalizations other than for an uncomplicated delivery 8 years ago. Her only medication, other than the recent use of acetaminophen, is an oral contraceptive pill that she has taken for the past 4 years. She denies using any tobacco, alcohol, or recreational drugs.

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