CASE 33: HEADACHES AND CONFUSION
History
A 28-year-old black South African theatre nurse in London is admitted to the emergency
department complaining of headaches and confusion. Her headaches have developed over
the past 3 weeks and have become progressively more severe. The headaches are now per-
sistent and diffuse. Her friend who accompanies her says that she has lost 10 kg in weight
over 6 months and has recently become increasingly confused. Her speech is slurred.
While in the emergency department she has a generalized tonic–clonic convulsion.
Examination
She is thin and weighs 55 kg. Her temperature is 38.5°C. There is oral candidiasis. There is
no lymphadenopathy. Examination of her cardiovascular, respiratory and gastrointestinal
systems is normal. Neurological examination prior to her fit showed her to be disorien-
tated in time, place and person. There were no focal neurological signs. Funduscopy
shows bilateral papilloedema.
NormalHaemoglobin 12.2 g/dL 11.7–15.7 g/dL
White cell count 12.1% 109 /L 3.5–11.0% 109 /L
Platelets 365 % 109 /L 150–440% 109 /L
Sodium 126 mmol/L 135–145 mmol/L
Potassium 3.9 mmol/L 3.5–5.0 mmol/L
Urea 6.2 mmol/L 2.5–6.7 mmol/L
Creatinine 73 &mol/L 70–120&mol/L
Glucose 5.6 mmol/L 4.0–6.0 mmol/LA computed tomography (CT) scan is shown in Fig. 33.1.INVESTIGATIONS
Figure 33.1Computed tomography scan of
the brain.Questions
- What is the cause for this woman’s headaches, confusion and fits?
- What is the underlying diagnosis?
- How should this woman be further investigated and treated?