Question of the Week #489

A 35 Year old woman presents for evaluation of recurrent headaches for the past few months.  Lately, she has been waking up with a headache almost daily though it tends to improve in the latter half of the day. She is frustrated as she can not even get some sleep during the attack since lying down makes her feel worse . She has associated nausea. She has transient attacks of light flashes  that resolve spontaneously. Her menstrual history is unremarkable. On physical examination, she has no neurological deficits. Funduscopic examination shown below: QBANK INSTA AD

Which of the following information, if elicited in the patient history, would increase the clinical suspicion of the diagnosis?

A)     Constipation

B)     Family history

C)      Recent weight gain

D)      Galactorrhea

E)   Urinary Incontinence

2 Responses

  1. D

  2. Answer: C
    Clinical picture is consistent with Pseudotumor Cerebrii or Idiopathic Intracranial Hypertension ( IIH). In this condition, patients often have headaches that are worse in the morning. Papilledema is present in most cases. In the above image, funduscopy shows papilledema. Changes in headache with posture i.e; headache that is made worse on lying down is characteristic of pseudorumor cerebrii ( lying supine increases CSF pressure further).

    Other than obesity, the association between other medical conditions and IIH is not proven. Patients should be questioned about recent weight-gain or pregnancy as these seem to be associated with IIH.
    Constipation may be seen in hypothyroidism however, the association between hypothyroidism and IIH is not proven.

    Family history is not a proven risk factor in IIH.

    Galactorrhea can be seen with prolactin producing brain tumors which can also cause headaches – however, her normal menstrual periods, postural changes in the headache favors the diagnosis of IIH more.

    Urina0ry incontinence is seen with Normal Pressure Hydrocephalus (NPH however, papilledema is not seen in NPH

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