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[Intracranial hypotension or hypovolemia can occur with even trivial trauma like weight lifting and is characterized by a positional headache: worse upon being upright and better when lying down.Small amounts of diplopia usually from sixth nerve palsies can occur.There are typical imaging...
[Ask about GCA symptoms in your ROS for elderly patients with new eye pain or headache.Check both ESR and CRP when evaluating for GCA.A temporal artery biopsy can be performed within 10–14 days of starting prednisone.Headaches unresponsive to steroids are less likely to be GCA-related.]
[All thunderclap onset headaches need extensive evaluation to rule out a secondary cause.Check the history for risk factors—e.g. medications, pregnancy for RCVS.Treatment of RCVS is generally with calcium channel blockers.]
[The triad of fever, headache/eye pain, and stiff neck should lead you to consider meningitis as a cause of eye pain.Aseptic meningitis can be caused by a multitude of entities including: viral, fungal, tuberculous, drugs, and autoimmune disease.Tuberculous meningitis is notoriously difficult to...
[Eye pain with eye movement and visual loss, should raise the possibility of opticneuritis. The finding of the RAPD with eye pain can be very helpful.Other neurologic findings should raise the suspicion for systemic diseases such as MS and NMO.MR imaging usually with gadolinium and orbital views...
[Always examine the fundus—looking for papilledema in anyone with new eye pain and headache.Follow the visual field as well as the optic disc in IIH.IIH without papilledema is rare.Headache improvement with LP does not mean that the pain is from high pressure.Treat with weight loss and...
[C-C fistula can cause a red, painful eye without discharge or tearing.Pulse synchronous tinnitus commonly occurs with C-C fistula.Although CT/CTA and MRI/MRA can often diagnose C-C fistula, angiography may be required.]
[Herpes Zoster ophthalmicus causes eye pain—and risk factor is age. The pain may precede the rash, making the diagnosis more difficult.Early treatment with antivirals may help reduce the pain and the severity of post-herpetic neuralgia.Watch for ocular and neurologic complications.]
[Look for scars on the face and inquire about previous skin cancers with painful ophthalmoplegia.Check facial sensation in patients with eye pain. Numbness is concerning for compressive etiologies. Numbness plus pain is bad!Tolosa Hunt is a diagnosis of exclusion. Biopsy may be indicated.]
[Tolosa Hunt Syndrome is a diagnosis of exclusion—always consider a secondary cause of the syndrome!Work patients ups completely with imaging and labs.Poorly responsive or steroid-responsive disease may require a biopsy.Radiation is a potential treatment option if the biopsy is negative.]
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