Question

A 35-year-old woman with a history of migraines and polycystic kidney disease presents to the Emergency Department with a severe, diffuse headache. The onset was abrupt approximately one hour prior to arrival. Her vital signs are within normal limits. She has photophobia and phonophobia, as well as pain with extraocular movements. Which of the following is the most likely diagnosis?

A) Classic migraine
B) Idiopathic intracranial hypertension
C) Meningitis
D) Subarachnoid hemorrhage

Answer 1

The most likely diagnosis for the 35-year-old woman with a severe, diffuse headache, and other noted symptoms is subarachnoid hemorrhage, due to the sudden onset and her medical history. A migraine, idiopathic intracranial hypertension, and meningitis are also considered but are less probable given the clinical presentation.

Step-by-step explanation:

Differential Diagnosis for Severe Headache

The clinical presentation of a severe, diffuse headache with sudden onset, photophobia, phonophobia, and pain with extraocular movements can indicate several potential diagnoses. In this scenario, the most likely diagnosis is subarachnoid hemorrhage (D), given the abrupt onset and the patient's history of polycystic kidney disease which can be associated with an increased risk of intracranial aneurysms. It is a critical condition and warrants immediate attention. While a classic migraine (A) could present with photophobia and phonophobia, the abrupt onset and severity are less characteristic. Idiopathic intracranial hypertension (B) and meningitis (C) can also cause headaches and visual symptoms, but the patient's presentation and lack of additional symptoms such as fever, confusion, or neck stiffness make these less likely compared to a subarachnoid hemorrhage. Comprehensive evaluation, including imaging such as a CT scan or lumbar puncture, is needed to confirm the diagnosis and guide treatment.