Hydrocephalus

Case #6: MRI Brain: Communicating hydrocephalus.

CC: Headache

Hx: This 18y/o RHF began experiencing central headaches on 11/13/92. She had a history of sinus headaches in the past which responded to over-the-counter analgesics. However, her current headaches had not responded to these medications. On 11/13/92 she began noticing "black" areas within her visual field while watching a movie. This was followed by a sharp midline headache that persisted for 4.5 hours. The visual change persisted during the headache. In addition, during one headache, she experienced a 2 minute period of garbled speech and 7-8 minutes of tingling in the right arm. The headaches were sharp in character and had been waxing and waning throughout the day since onset. She denied bowel or bladder retention or incontinence. She denied any history of meningitis. She had no history of trauma at birth or abnormal development.

PMH: 1)Chronic UTI, 2)S/P Tonsillectomy and adenoidectomy.

FHx: MGF suffered a stroke at unknown age. No history of headache.

SHx: Freshman at University of Iowa. Denied tobacco or illicit drug use. Rarely consumes ETOH.

MEDS: Oral birth control pills, and macrodantin for chronic UTI.

EXAM: BP110/72 HR72 RR12 T36.7C Wt 65kg HT168cm

MS: A and O x 3. Normal speech. Lucid thought process.

CN: unremarkable. no papilledema visualized on fundoscopic exam.

Motor: full strength with normal muscle bulk and tone.

Sensory: unremarkable.

Coordination: unremarkable.

Station/Gait: unremarkable, no ataxia or gait apraxia.

Reflexes: 2+ throughout.

Gen Exam: unremarkable.

Course: MRI Brain, 11/23/92, showed a larger than average ventricular system. She underwent lumbar puncture (opening pressure 17cm H20, RBC 1, WBC 0, Glucose 52, (Serum Glucose 86), protein 27, cultures negative.

The patient's ventriculomegaly was felt to represent a normal variant. She was taken off macrodantin, as this has been remotely associated with hydrocephalus. She also discontinued her birth control pills. The headaches subsequently resolved.