What is the diagnosis for a patient experiencing increasing forgetfulness, nausea, vomiting, and a bandlike throbbing headache with exacerbating factors of light and sound, who has a history of a rash and an upcoming magnetic resonance imaging (MRI) of the brain, and is requesting a positron emission tomography (PET) scan due to concerns about cancer?

From the Guidelines

The patient should proceed with the scheduled brain MRI as the initial imaging study to evaluate her cognitive changes and headaches, rather than a PET scan, due to its higher sensitivity and specificity for detecting brain metastases and other structural abnormalities. The patient presents with a history of progressive forgetfulness over the past month, accompanied by a bandlike, throbbing headache (rated 6/10) that began a couple of months ago. The headache is exacerbated by light and sound and associated with nausea, but without radiation. She reports recent hospital visits for nausea, vomiting, and a rash that responded to medication. She has had a CT scan of her head and is scheduled for a brain MRI but is requesting a PET scan due to cancer concerns. The patient previously wore glasses but has stopped wearing them recently. Based on these symptoms, the most probable diagnosis is migraine headaches with possible cognitive changes that warrant further investigation. According to the guidelines outlined in 1, cranial MRI is the gold standard for neuroradiological assessment of patients with suspected brain metastases, and it provides detailed structural imaging of the brain. While a PET scan can be useful for detecting metabolic changes associated with certain neurological conditions or malignancies, as discussed in 1, it is typically not the first-line imaging study for these symptoms and should be considered only if the MRI results are inconclusive or if specific clinical indications arise. Additionally, the patient should be referred to neurology for comprehensive evaluation of her headaches and cognitive symptoms, and an ophthalmology assessment is recommended to address her vision needs since she has stopped wearing her glasses. Key points to consider in the patient's management include:

• Proceeding with the scheduled brain MRI as the initial imaging study
• Referral to neurology for comprehensive evaluation of headaches and cognitive symptoms
• Ophthalmology assessment to address vision needs
• Consideration of a PET scan only if MRI results are inconclusive or if specific clinical indications arise, as per the guidelines in 1.

From the Research

Patient Concerns and Symptoms

• The patient is experiencing increasing forgetfulness, nausea, vomiting, and a rash, which prompted her to visit multiple hospitals.
• She has a CT scan of her head and is concerned about cancer, with an upcoming MRI of the brain scheduled.
• The patient is requesting a PET scan due to her symptoms, and education was provided regarding the cost.

Imaging and Diagnostic Procedures

• Positron emission tomography (PET) is a radiotracer imaging method that yields quantitative images of regional in vivo biology and biochemistry, as discussed in 2.
• PET/CT devices have had a significant impact on cancer diagnosis and treatment, and are now an important part of oncologic clinical practice and translational cancer research, as noted in 2.
• The use of MRI and PET is expanding, and patients who undergo such procedures require careful anaesthesia and monitoring within an isolated and unfamiliar environment, as mentioned in 3.

Patient Assessment and Communication

• Assessing patient concerns is associated with increased patient satisfaction, and unvoiced concerns can lead to unresolved health issues and poor doctor-patient relationships, as found in 4.
• Patient concern assessment studies are mostly qualitative in nature, and interviews are more reliable sources of information than questionnaires, as discussed in 4.
• Clinicians should understand the implications of recommendations, assess the trustworthiness of the development process, and evaluate the extent to which the recommendations are applicable to patients in their practice settings, as suggested in 5.

Management and Support

• Agitation is a symptom of many medical and psychiatric disorders, and management centers around early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel, as mentioned in 6.
• Nurses should increase use of validated techniques, including frequent and sufficient reality orientation, validation therapy, and strategies that improve the individual's quality of life, as recommended in 6.