A 77-Year-Old Retired Teacher With a Constant Headache

Amanda L. Blackmon, DO, MS; Lauren Pinter-Brown, MD

Disclosures

July 05, 2019

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 that you would like to suggest for a future Case Challenge, please contact us.

Background

A 77-year-old retired teacher presents to the emergency department with dizziness, imbalance, nausea/vomiting, and a constant headache for the past 2 weeks. He describes his headache as diffuse and throbbing. His history is significant for hepatitis C; hypothyroidism; Helicobacter pylori infection; and mantle cell lymphoma, which was diagnosed 2 years ago and is currently in remission. The patient is taking rituximab for maintenance therapy. He takes lorazepam nightly for sleep.

The patient reports having traveled to Brazil 3 weeks ago. His family describes the patient as having been more confused than usual. He has been around his grandchildren, who attend a daycare center. He has a 40–pack-year smoking history and quit smoking 30 years ago. He reports occasional alcohol use and denies illicit drug use. He currently lives with his significant other. He is HIV negative. His vaccination status is unknown.

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