A 22-Year-Old Woman Comes to the Emergency Department Due to Acute

question 181

Multiple Choice

A 22-year-old woman comes to the emergency department due to acute vision disturbances and headache.  About an hour ago the patient experienced a small area of visual loss, which she describes as a hole in the visual field.  The vision disturbance gradually expanded to a C-shape in her peripheral vision and spontaneously resolved after 15-20 minutes.  A progressively worsening, severe, right-sided headache of pulsating quality quickly followed.  The patient has had similar headaches in the past but not of such severity.  She has no other medical conditions and takes no medications.  Blood pressure is 150/86 mm Hg and pulse is 92/min.  On physical examination, the patient is lying still in bed with eyes closed.  The pupils are equal and reactive to light.  Funduscopic examination reveals no abnormalities.  Bilateral upper and lower extremity muscle strength, deep tendon reflexes, and sensation are normal.  Which of the following is the most likely diagnosis?

• A)Acute angle-closure glaucoma
• B)Cluster headache
• C)Migraine with aura
• D)Optic neuritis
• E)Simple partial seizure
• F)Transient ischemic attack

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C$1,500

Canadian dollars one thousand five hundred, often used in financial transactions to denote currency amount.

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