"Worst headache ever."Challenge 1: What are you looking at?
Related Questions:
1. What happened?
2. What's the cause?
3. What are the risk factors?
4. What is the initial work-up?
Young adult, low back pain, limited spinal mobility, with acute anterior uveitis.Challenge 2: This is associated with a specific genotype. What is it?
Fatigue, infection, gingival bleeding.Challenge 3: Diagnosis?
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Neurons that Fire Together, Wire Together
The first case is a subarachnoid hemorrhage from a ruptured saccular aneurysm. Risk factors include smoking, HTN, EtOH, FHx. It is a medical emergency presenting with acute onset thunderclap headache and may include loss of consciousness, nausea, vomiting, seizures, meningismus. Diagnosis is by non-contrast head CT. If head CT is normal, then LP is mandatory. Classic LP findings include elevated opening pressure, elevated RBC count that does not diminish, and xanthochromia (shown here) which is pink or yellow tint to the CSF representing hemoglobin degradation products.
The second case is ankylosing spondylitis, a chronic inflammatory condition of the axial skeleton with back pain and spine stiffness. It has an association with HLA-B27. The “bamboo” spine on X-ray represents early inflammatory and destructive spinal involvement with squaring of vertebral bodies. Uveitis is the most common extraarticular manifestation (acute unilateral pain, photophobia, blurring of vision).
The last case is acute myeloid leukemia, diagnosed by presence of Auer rods, presenting with pancytopenia.
Sources: UpToDate; www.webmm.ahrq.gov (first case); courses.washington.edu (second case); healthsystem.virginia.edu (third case).
ohhh, i thought all 3 pictures were the same disease.. so i couldn't figure it out.
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