Monday, November 28, 2011

Demon

A 30 year old man is brought in by police for a suicide attempt; he was found on a bridge, ready to jump. He says he wants to commit suicide because of symptoms exactly as those shown above: severe left orbital 10/10 pain occurring 6 times a day. All he can do is pace about or rock back and forth in his chair, waiting for the pain to stop. It's so excruciating that the affected eye waters and he gets congested. He's thought about committing suicide multiple times when these attacks start, especially after enduring them for a week, but each time he gets to the bridge, the pain stops for a few weeks.

Suddenly, the patient screams in pain and starts clutching the side of his head saying he is having an attack. On exam, you wonder if he has a unilateral Horner's syndrome. You're not sure because he does seem to sweat. His eye is pretty red and you wonder about conjunctivitis. The patient can't give further history but says it'll get better within the next 15-30 minutes. The rest of the exam is unremarkable, except for a pack of cigarettes in his shirt pocket.

Challenge: Other than danger to self, what's the diagnosis?

Image is shown under GNU Free Documentation License.

8 comments:

Anonymous said...

trigeminal neuralgia

jimmy said...

Cluster headache- had a patient couple years ago, and had good results with oxygen therapy....

Reflex Hammer said...

Cluster headache triggered by tobacco use?

(I had to look it up)

Anonymous said...

Cluster headache

Joke Meijer said...

Maybe; Clusterheadache in combination with Horner's syndrome.

Horner can cause serious limbal rednes, so its not a conjunctivitis.

sid said...

Cluster headaches

miko said...

Cluster headache?

Craig Chen said...

yes indeed, this is cluster. it looks awfully painful.
-
Demon

This is cluster headache, a type of trigeminal autonomic cephalgia, an idiopathic short-lasting unilateral severe headache accompanied by autonomic symptoms.

Sources: UpToDate; Wikipedia.