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A Case Of Headache and Intracranial Calcifications in the Emergency Department
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Available online at www.sciencedirect.com
Visual Journal of Emergency Medicine 2C (2016) 33–34 www.elsevier.com/locate/visj
A Case Of Headache and Intracranial Calcifications in the Emergency Department Tyler Beals, MDn, Leily Naraghi, MD, Sergey Motov, MD Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, NY
Keywords: neurocysticercosis; headache; computed tomography
Visual Case Discussion A 23-year old, Guatemalan, otherwise healthy male, presented to the Emergency Department (ED) with bifrontal headache for 1 day. The headache started suddenly and was intermittent, throbbing, and radiating to his neck. He had no history of headaches. He had no photophobia, visual changes, nausea, vomiting, fever, seizures, or history of trauma. In Guatemala, he worked on a farm milking cows, and since moving to New York 2 years prior to this ED
Fig. 1. Computed tomography of brain showing multiple coarse calcifications scattered throughout the supratentorial parenchyma and within the subarachnoid spaces.
n
Corresponding author. E-mail address: [email protected] (T. Beals).
http://dx.doi.org/10.1016/j.visj.2015.10.001 2405-4690/& 2015 Elsevier Inc. All rights reserved.
34
T. Beals et al. / Visual Journal of Emergency Medicine 2C (2016) 33–34
Fig. 2. MRI of brain with IV contrast showing numerous non-enhancing punctate foci in the deep parenchymal and superficial cortical spaces.
visit, had been working in a restaurant. The physical exam revealed a tired, uncomfortable-appearing young man. Otherwise his physical and neurologic exams were normal. Laboratory work was unremarkable. Administration of metoclopramide, diphenhydramine, and ibuprofen in the ED provided minimal relief of his pain. CT and MRI of the brain confirmed the diagnosis (Figs. 1 and 2). He was admitted to the hospital, received treatment with dexamethasone and ibuprofen, and was released with resolution of symptoms after 2 days. Appendix. Supplementary Materials Supplementary material cited in this article is available online at http://dx.doi.org/10.1016/j.visj.2015.10.001. References [1] O'Neal SE, Flecker RH. Hospitalization frequency and changes for neurocysticercosis, United States, 2003–2012. Emerg Infect Dis 2015;21 (6):969–76. [2] Garcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 2014;13(12):1202–15. [3] Kıroğlu Y, Callı C, Karabulut N, Oncel C. Intracranial calcifications on CT. Diagn Interv Radiol 2010;16(4):263–269.
Available online at www.sciencedirect.com
Visual Journal of Emergency Medicine 2C (2016) 33–34 www.elsevier.com/locate/visj
A Case Of Headache and Intracranial Calcifications in the Emergency Department Tyler Beals, MDn, Leily Naraghi, MD, Sergey Motov, MD Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, NY
Keywords: neurocysticercosis; headache; computed tomography
Visual Case Discussion A 23-year old, Guatemalan, otherwise healthy male, presented to the Emergency Department (ED) with bifrontal headache for 1 day. The headache started suddenly and was intermittent, throbbing, and radiating to his neck. He had no history of headaches. He had no photophobia, visual changes, nausea, vomiting, fever, seizures, or history of trauma. In Guatemala, he worked on a farm milking cows, and since moving to New York 2 years prior to this ED
Fig. 1. Computed tomography of brain showing multiple coarse calcifications scattered throughout the supratentorial parenchyma and within the subarachnoid spaces.
n
Corresponding author. E-mail address: [email protected] (T. Beals).
http://dx.doi.org/10.1016/j.visj.2015.10.001 2405-4690/& 2015 Elsevier Inc. All rights reserved.
34
T. Beals et al. / Visual Journal of Emergency Medicine 2C (2016) 33–34
Fig. 2. MRI of brain with IV contrast showing numerous non-enhancing punctate foci in the deep parenchymal and superficial cortical spaces.
visit, had been working in a restaurant. The physical exam revealed a tired, uncomfortable-appearing young man. Otherwise his physical and neurologic exams were normal. Laboratory work was unremarkable. Administration of metoclopramide, diphenhydramine, and ibuprofen in the ED provided minimal relief of his pain. CT and MRI of the brain confirmed the diagnosis (Figs. 1 and 2). He was admitted to the hospital, received treatment with dexamethasone and ibuprofen, and was released with resolution of symptoms after 2 days. Appendix. Supplementary Materials Supplementary material cited in this article is available online at http://dx.doi.org/10.1016/j.visj.2015.10.001. References [1] O'Neal SE, Flecker RH. Hospitalization frequency and changes for neurocysticercosis, United States, 2003–2012. Emerg Infect Dis 2015;21 (6):969–76. [2] Garcia HH, Nash TE, Del Brutto OH. Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 2014;13(12):1202–15. [3] Kıroğlu Y, Callı C, Karabulut N, Oncel C. Intracranial calcifications on CT. Diagn Interv Radiol 2010;16(4):263–269.