16 year old female with headache

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A 16 year old female who is a student by occupation came to the old with complaints of headache since 3 months on left temporal region pulsating type radiating to parietal and occipital region,progressive type

Patient was apparently asymptomatic 1 month back and then she developed headache in left temporal region and radiating to occipital region .Headache is not associated with fever,cold,cough,associated with decreased appetite and headache relieved on medication.

Patient now presented with complaints headache since 3 to 4 days in left temporal region,pulsalite type,radiating to occiput region

Not associated with fever,cold,cough

Continuous type,pulsalite ,not increased on flashlights

No photophobia,diffuse distribution,not associated with heaviness

No complaints of nausea,vomiting

No h/o tb,asthma,epilepsy

No h/o blurred vision,dizziness

GENERAL EXAMINATION

Patient is conscious,coherent,cooperative,thin build,poorly nourished                                                                 Vitals: BP:   110/70mm hg.                                                                                                                                      Temp:afebrile                                                                                                                                                       Pulse:96 bpm. 

Rr :20/min                                                                                                                                                    Pallor present,no icterus,no cyanosis,no kylonychia,no lymphadenopathy

                                                                                                           

SYSTEMIC EXAMINATION:

Respiratory examination;bilateral air entry present,trachea central,normal vesicular breath sounds heard,no adventitious sounds heard

Per abdomen:                                                                                                                                                                  

Shape of the abdomen:shapoid                                                                                                                         No tenderness,no local rise of temperature                                                                                                       No palpable mass,hernial orifices free,no free fluid and bruit   ,liver and spleen are not palpable                   Bowel sounds:normally heard

CNS EXAMINATION

Higher mental functions:

Patient is conscious,coherent,cooperative,oriented to time,place,person                                                         Speech is normal in pitch and tone ,memory:recent and remote memory intact

Cranial nerves:all cranial nerves intact

Motor system:

TONE:                          UL                                 LL

      Rt                             N                                   N

      Lt                            N                                   N

BULK                       UL                                   LL

       Rt                       N                                     N

      Lt                         N                                     N

POWER                   UL                                   LL

          Rt                    5/5                                    5/5

          Lt                      5/5                                   5/5

Sensory system

Fine touch              N

 Crude touch.          N.                                                                                                                                       

Pain/temp.              N

Vibration.               N

Joint position.        N

Deep tendon reflexes

Biceps                     +                                        +

Triceps                   +                                         +

Supinator                +                                         +

Knee                       +                                         +

Ankle                      +                                        +

Cerebellum: no finger nose incordination

Knee heel test:normal

CVS EXAMINATION:

s1 and s2 heard

Investigations:

Provisional diagnosis:Headache under evaluation 

TREATMENT:

1)Tab PCM 650 mg p/o sos

2)Tab   Livogen 150 mg   1/2 hr before food

3) inj.hydroxycobalamin   1500pg Iv in 100 ml ns OD

4)2 egg whites per day

5)Tab limcee 500mg   Po/OD    Before food

6)grbs,by daily once