Neurology Main神经内科 51-60-课件.pptVIP

Neurology Main 51-60 Q 51A 35-year-old man comes to the emergency department due to severe pain behind his left eye. The patient reports that the pain is intense and stabbing and that it woke him up around midnight. It improved after 30 minutes and he was about to go back to sleep when the same pain began again. He took ibuprofen without relief. Several months ago, the patient had similar episodes of pain that resolved spontaneously after 2 weeks. He has had no fevers, blurry vision, nausea, or vomiting but has had nasal congestion. The patient has seasonal allergies for which he takes cetirizine. He works as a flight operations officer and describes his job as pretty stressful.” He drinks 2 or 3 cups of coffee daily and drinks alcohol occasionally. His mother has migraine headaches. Temperature is 36.7 C (98 F): blood pressure is 140/90 mm Hg; and pulse is 94/min. The patient is restless and agitated. Physical examination shows left-sided ptosis; miosis, and rhinorrhea. Neurologic examination shows bilateral equal and normal motor strength, sensation, and deep tendon reflexes. Which of the following is the most likely cause of this patients headache?A. Acute maxillary sinusitis B. Angle closure glaucoma C. Brain tumor D. Cluster headache E. Lacunar infarction F. Migraine without aura G. Orbital cellulitis H. Retinal detachment I. Subarachnoid hemorrhage J. Substance abuse disorder K. Tension-type headache L. Trigeminal neuralgia A 51Correct answer:DThis patient with acute left retro-orbital pain that resolves and recurs and is accompanied by ipsilateral autonomic manifestations (eg, ptosis [droopy eyelid], miosis [pupillary constriction], rhinorrhea) likely has cluster headaches. These episodes are generally seen in young menr are unilateral and can be accompanied by redness of the ipsilateral eye with tearing but no visual changes, as well as by agitation due to the severity of the pain.The paroxysms of cluster headache attacks begin during sleep, peak rapidly, la