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All the places you will go… Gina Petrakos PGY-3 MouNt SINai Medical Center MIami BeaCH, FL

All the places you will go… Gina Petrakos PGY-3 MouNt SINai Medical Center MIami BeaCH, FL october 14, 2014.

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All the places you will go… Gina Petrakos PGY-3 MouNt SINai Medical Center MIami BeaCH, FL

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  1. All the places you will go… • Gina Petrakos PGY-3 • MouNt SINai Medical Center • MIami BeaCH, FL • october 14, 2014

  2. 33 yo male c/o headaches & neck pain. Headaches began 12 days ago and were gradual in onset with no trigger. Pain is located frontal bilaterally & radiates into his neck. The pain is becoming more constant and characterized as aching & pressure-like. He reports associated symptom of diplopia, congestion and nausea that are gradually worsening. Pt states he has tried Meclizine for the pain without relief. He reports no other modifying factors. • Of Note: this is NOT the worst headache of his life, he reports no new trauma & no history of migraines. Patient Presents to Your ED….

  3. PMHx: 1. Chronic left eye vision loss which he attributes to questionable small pox as child. 2. Pt diagnosed by ENT with left acoustic neuroma & sinusitis by MRI 2 months prior after hearing loss in left ear • Rx: Meclizine PRN received after Dx: acoustic neuroma • Sx: Partial amputation of right 3rd finger • NKDA • FamHx: No heart Dz, cancer or infectious diseases • SocHx: From New Delhi, India. Married & monogamous, worked on cruise line times x 7 yrs. No sick contacts. Travels throughout Caribbean & back to India. Never used tobacco, EtOH or illicit drugs

  4. Review of systems • Const: (-) for fever, chills • HENT: (+) for congestion. (-) for sore throat, dysphagia • Eyes: (+) for diplopia. (-) for photophobia, blurry vision • Resp: (-) for cough, SOB • CV: (-) for chest pain, palpitations, leg swelling, syncope • GI: (+) for nausea, (-) for vomit, diarrhea, abd pain • GU: (-) for flank pain or dysuria • MS: (+) for neckpain. (-) for back pain or neck stiffness • Neuro: (+) for headaches, dizziness. (-) for seizures • Psych: (-) for insomnia,confusion or behavior problems

  5. Physical Exam • VS: 119/85 Pulse 64 Resp 20 98.4 oral 100% on RA BMI: 24.3

  6. Labs: • Na2+ 138 • K+ 3.7 • Cl- 102 • CO2 29.0 • Glu 99 • BUN 9.0 • Cr 0.7 • AG 7.0 • GFR > 60 • Osmol 274 • WBC 10.5 • HMG 15.6 • HCT 46.9 • PLT 287 • LYMPH 15.1 • NEU %: 77.9 • MONO 5.9 • EOSIN 0.3 • AB NEU 8.24 • IMMATURE GRAN 0.6

  7. CT Angiogram head & Neck

  8. CT Angiogram head & Neck

  9. What is your differential diagnosis? • What diagnostic test(s) would you order to confirm a diagnosis? • What is your disposition on this patient?

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