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Cephalgia!

Topic: Adult

Created on Saturday, November 8 2008 by rednucleus

Last modified on Saturday, November 8 2008.

A 21-year-old woman presents with headache. Her headache is generalized, present most of the day and most of the year, and for the last 2 years. It is poorly responsive to indomethacine but responds well to amitriptyline. The cranials are intact, but you have detected bilateral stork-limbs, pes cavus, and palpable common peroneal nerves. What is the cause of her headache?

A) Motor neuron disease

B) Hemicrania continua

C) Charcot-Marie-Tooth disease

D) Chronic tension type headache

E) Falx meningioma

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This question was created on November 08, 2008 by rednucleus.
This question was last modified on November 08, 2008.

ANSWERS AND EXPLANATIONS

A) Motor neuron disease

This answer is incorrect.

Does not fit; her pes cavus, stork-like legs, and the palpable common peroneals are pointing towards Charcot-Marie-Tooth. (See References)


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B) Hemicrania continua

This answer is incorrect.

The headache must be unilateral, with cranial autonomic dysfunction. (See References)


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C) Charcot-Marie-Tooth disease

This answer is incorrect.

The patient did not tell us about her Charcot-Marie-Tooth, but we can conclude that this disease is already present for many years and has no relation with her current chronic tension-type headache which is her concern. Don’t forget co-pathologies, and that some patients are poor historians! (See References)


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D) Chronic tension type headache

This answer is correct.

This is occurring on the background of her Charcot-Marie-Tooth; this is her headache cause. The patient did not tell us about her Charcot-Marie-Tooth, but we can conclude that this disease is already present for many years and has no relation with her current chronic tension-type headache, which is her actual concern. Don’t forget co-pathologies, and that some patients are poor historians! (See References)


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E) Falx meningioma

This answer is incorrect.

May produce headache and spastic paraparesis that don’t fit our patient; her pes cavus, stork-like legs, and the palpable common peroneals are pointing towards Charcot-Marie-Tooth. (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
Cephalgia!
Question ID: 110808089
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 11/08/2008
Modified: 11/08/2008
Estimated Permutations: 120