USMLE Forum Archives - USMLE Step 3 - Pregnant lady with headache
Pregnant lady with headache
harry206 - 05-04-09 11:43
A 20-year-old Caucasian female, gravida 1 para 0, presents to the emergency department (ED) at 24 weeks of gestation with a severe headache. Her headache began four hours ago, and gradually increased in intensity. She currently describes the pain as 8-9 on a scale from 1 to 10. She had one episode of vomiting. She denies any history of head trauma or loss of consciousness. Her past medical history is insignificant. She denies the use of tobacco, alcohol, or illicit drugs. Her temperature is 36.7C(98F), blood pressure is 120/76 mm Hg, pulse is 80/min, and respirations are 16/min. The physical examination reveals right hemiparesis with slight asymmetry of deep tendon reflexes. Meningeal signs are negative. Brain imaging shows a small area of hemorrhage in the left hemispheric white matter, and a thrombus in the superior saggital sinus. Which of the following is the best management strategy for this patient?
harry206 - 05-04-09 11:43
A 20-year-old Caucasian female, gravida 1 para 0, presents to the emergency department (ED) at 24 weeks of gestation with a severe headache. Her headache began four hours ago, and gradually increased in intensity. She currently describes the pain as 8-9 on a scale from 1 to 10. She had one episode of vomiting. She denies any history of head trauma or loss of consciousness. Her past medical history is insignificant. She denies the use of tobacco, alcohol, or illicit drugs. Her temperature is 36.7C(98F), blood pressure is 120/76 mm Hg, pulse is 80/min, and respirations are 16/min. The physical examination reveals right hemiparesis with slight asymmetry of deep tendon reflexes. Meningeal signs are negative. Brain imaging shows a small area of hemorrhage in the left hemispheric white matter, and a thrombus in the superior saggital sinus. Which of the following is the best management strategy for this patient?
The correct answer and explanation will be available after you answer.
Page 1
#6
Re: Pregnant lady with headache
harry206 - 05-05-09 12:11 Explanation:
Superior saggital sinus thrombosis
This is a rare condition that can be associated with trauma, infection, hypercoagulation, vasculitis, nephrotic syndrome, severe dehydration, and pregnancy.
The diagnosis is suggested by the history (headache, associated conditions), physical findings (hemiparesis, papilledema, seizure) and imaging tests.
MRI imaging and MR venography are very useful in establishing the diagnosis.
The management of patients typically includes adequate anticoagulation with heparin, even if an area of hemorrhagic infarction is demonstrated on CT.
It is important to understand that the hemorrhagic foci that occur in this case are secondary to venous hypertension.
Warfarin is useless in the acute setting because it requires some time to start anticoagulation. Furthermore, its use is not recommended during pregnancy.
#8
Re: Pregnant lady with headache InSitu - 05-05-09 14:52 
posted by meduploader on 05-05-09 14:45
e. Administer heparin
e. Administer heparin
Doc Meduploader PLEASE use the new musltiple choice feature so that the stats are more accurate. thanks
#9
Re: Pregnant lady with headache InSitu - 05-05-09 14:53 to use that feature just click on the radio button next to t he choice and click submit answer. Its simple.
#38
Re: Pregnant lady with headache baloch1234 - 10-21-11 17:56 My answer is: e.
warfarin is useless in pregnancy &this patient needs anticoagulant so drug of choice is heparin
#47
Re: Pregnant lady with headache chandan - 12-16-11 04:50 My answer is: b.
as there is haemorrhage so heparin & warfarin cant use
#53
Re: Pregnant lady with headache msersy - 01-04-12 09:43 My answer is: a.
FOR BEST MANGMENT OF THE CONDITION
Page 1