Differential Diagnosis for 83 YO Female with Headache
- Single most likely diagnosis
- Thunderclap headache due to reversible cerebral vasoconstriction syndrome (RCVS) or migraine: The patient's description of a thumping headache, similar to a heartbeat, and the transient numbness in her left hand fingers could suggest a vascular cause. Although she doesn't have a history of migraines, the symptoms could be indicative of a migraine variant or RCVS, especially given her age and the presence of hypertension.
- Other Likely diagnoses
- Hypertensive emergency: Given her history of hypertension and the sudden onset of a severe headache, it's possible that she's experiencing a hypertensive emergency, which could be causing her symptoms.
- Temporal arteritis: Although less common in this age group without other symptoms like jaw claudication or visual disturbances, temporal arteritis could still be a consideration, especially with the patient's age and the presence of a headache.
- Medication-overuse headache: The patient has been taking panadol, which could potentially lead to medication-overuse headache, although this seems less likely given the acute onset and severity of her symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage (SAH): Although the patient's symptoms don't perfectly align with a classic SAH presentation (e.g., sudden, severe headache, often described as "the worst headache of my life"), the possibility of SAH cannot be entirely ruled out without further investigation, such as imaging.
- Cerebral venous sinus thrombosis: Given her history of atrial fibrillation and use of apixaban, there's a potential risk for cerebral venous sinus thrombosis, which could present with headache and other neurological symptoms.
- Giant cell arteritis with impending stroke: While the patient doesn't have typical symptoms of giant cell arteritis, such as jaw claudication or visual disturbances, the condition can sometimes present atypically, and missing it could have severe consequences.
- Rare diagnoses
- Pituitary apoplexy: This condition, involving sudden hemorrhage or infarction of the pituitary gland, can present with severe headache, although it's relatively rare and would typically be accompanied by other symptoms such as visual disturbances or acute endocrine deficiencies.
- Cervicogenic headache: Although less likely, a cervicogenic headache, which originates from the cervical spine, could potentially cause the patient's symptoms, especially if there's an underlying cervical spine issue.