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 Best of Five 110

 

   

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BOF: 110

A 31-year-old female presents with a severe headache, which woke her up from sleep at approximately 3 a.m. She has never had a headache like this before. She had a mastoidectomy several years ago. She has no other symptoms and was otherwise well; she is not pregnant and was on no drugs in particular she was not on hormonal contraception.  She had not undertaken any severe exercise.

On examination she was afebrile, conscious and alert. On examination of the optic fundus the cup of the optic disc was filled and the medial margins of the disc were blurred. No other CNS abnormality in particular no neck stiffness. Examination of the other systems did not reveal any abnormality.

A CT scan was reported as normal by the duty radiology registrar, Full Blood Count was normal.

In this patient the investigation that is likely to lead to a diagnosis is:

a)      MR venogram

b)      Lumbar puncture

c)      Vitamin A level

d)      Cisternal puncture

e)      E.S.R. 

In this patient the treatment of choice would be:

a)      Heparin

b)      Steroids

c)      Vitamin A

d)    Acetazolamide

e)      Repeated lumbar puncture

 

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