Solve the Medical Riddle: She Has Had a Constant Headache for Two Weeks and Her Pupils Are Not the Same Size, Third Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient reported her symptoms to her PCP. The doctor proceeded with the examination using the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor recognized a potential medical emergency and transferred Chole to the Emergency Department immediately. Last week, we learned what happened when Chloe first arrived in the Emergency Department. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“Chloe’s doctor said she had normal blood pressure and pulse, so I guess he’s not worried about what my doctor called ‘pre-stroke’. I had ‘malignant hypertension’, meaning extremely high blood pressure that came on suddenly. They lowered it slowly over a matter of a few hours and I ended up with no organ damage and no stroke. That said, I still wonder if Chloe could have had a little stroke, what they call a transient ischemic attack or TIA. ”

— Julie R.

“Maybe Chloe has an aneurysm. I hope not because that wouldn’t be good news! A brain aneurysm is a bulging area in the wall of a blood vessel. The reason I know is that my brother who is about Chloe’s age had a brain aneurysm. It ruptured and bled and was a life-threatening emergency. His wife got him to urgent care immediately and he pulled through, but it was very frightening. We did learn, though, that many aneurysms don’t rupture and that there are treatments to keep them from rupturing.”

— Kay L.

“Could Chloe have a brain tumor? I imagine that the CT scan would show that. If she does have a tumor, I pray it’s not cancer! Of course even benign brain tumors can be dangerous, but a friend of mine had one and she had surgery to remonve the tumor. She’s hale and hearty four years later, thank goodness!”

— Marlene G.

“Is Chloe positive she never had unequal pupil size before she hit her head? Maybe she never really studied her eyes in the mirror before the headchaes started. I had an enlarged pupil that my eye doctor noticed. She said it was called benign anisocoria and I probably got it from stress. I had just gone trhough a divorce and we were in the middle of a custody battle. I ended up getting the kids. Eventually the anaocoria went away.”

— Susan F.

“Meningitis seems like a possibility to me, although a pretty remote one. Meningitis is an inflammation of the membranes around the brain and the spinal cord. Usually the cause is a viral infection. My daughter had it her freshman year of college. The symptoms were a lot like what Chloe describes. My daughter doesn’t remember hitting her head, though, so Chloe’s problems probably aren’t from an infection. Also, meningitis is most common in young adults, especially those who live in communal settings such as dorms. ”

— Deirdre M.

To be continued . . .

Come back to ThirdAge.com next Thursday when the doctor will reveal the actual diagnosis and treatment plan.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.