Neurology
Case 45: A Patient with Headaches and Temporary Loss of Vision
CASE
A 30‐year‐old policeman is referred because of headaches that have resulted in him having to take on average 2–3 days off work per month over a 6‐month period. About 50% of these headaches begin with progressive loss of vision, with an initial ‘smudge’ in the lower quadrant of his visual field which spreads until it leads to almost complete loss of vision for 10 minutes before resolving slowly over the next 15 minutes. A unilateral headache accompanied by nausea follows and lasts for 8 hours. During these episodes he feels ‘washed out’ and generally has to go to sleep. During the last 6 months the episodes have become more frequent and he reports a new feature that on several occasions instead of visual loss the headache has been preceded by numbness of the middle fingers of his right hand and a sense that he cannot find the correct words. In other ways the attacks proceed as before.
QUESTION 1
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Which of the following is the most appropriate initial management?