Solve the Medical Riddle: She Has Had a Constant Headache for Two Weeks and Her Pupils Are Not the Same Size, Second Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

Last week, the patient reported her symptoms. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor recognized a potential medical emergency and transferred Chloe to the Emergency Department immediately. This week, we’ll learn what happened when Chloe first arrived in the Emergency Department.

When Chloe arrived at the Emergency Department, a neurosurgery consultant who had been alerted to her imminent arrival was already on call when she got there. He remained on standby while Chloe had a CT scan. A CT scan is sufficient and it’s usually done on an urgent basis for head trauma. It is the “gold standard”, and less costly than an MRI that may not be necessary or available as quickly or easily.

A non-contrast CT — no need for dye — showed a crescent shaped mass between the skull and surface of the cerebral hemisphere that extended beyond the suture line of the brain. There was minimal midline shift of about 5 mm consistent with mild swelling pushing brain slightly to one side.

To be continued . . .

Come back to ThirdAge.com next Thursday to find out what some people have guessed the diagnosis might be.