Headache 351333.A 22-year-old woman with known IIH who is scheduled for a ven-
triculoperitoneal shunt in 2 weeks presents to the ED complaining of severe
headache. She states the headache is similar to the normal headaches asso-
ciated with her condition except that it is refractor to her regular medica-
tions, including triptans, and opiates. Her neurologist increased her dose of
acetazolamide, but this also did not help. Her noncontrast head CT is
unchanged from previous and she does not have papilledema. Which of the
following is likely to provide prompt relief?
a. IV corticosteroids
b. Infusion of mannitol
c. LP with removal of 15 cc of CSF
d. IV metoclopramide
e. Nonsteroidal anti-inflammatory drugs (NSAIDs)
334.A 55-year-old woman with a past medical history of diabetes presents to
the ED with fevers, headache, vision complaints, and right-sided weakness.
She was treated for otitis media 2 weeks ago with amoxicillin as an outpatient.
You obtain the CT scan seen below. What is the most likely diagnosis?
a. Central nervous system (CNS) toxoplasmosis
b. Subdural hygroma
c. Glioblastoma multiforme
d. Brain abscess
e. SAH
(Reproduced, with permission, from Schwartz DT, Reisdorff EJ.Emergency Radiology.
New York, NY: McGraw-Hill, 2000: 430.)