Headache, Confusion, And Chronic Rhinorrhea

Consult Page

14F with chronic sinusitis, prior meningitis pw headache, confusion, leakage from nose. Head CT unrevealing. Imaging recs?

Initial Imaging

Walking Thoughts

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  What is the patient’s current neurological exam?

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  What are her current vitals?

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  What symptoms has she been having and what is the timeline?

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  What is leaking from her nose? Is it clear? How long has she had this leakage?

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  When did she have meningitis? What was the cause and how was it treated?

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  Is there concern for meningitis or a cerebrospinal fluid leak?

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  With a reportedly negative head CT, what additional imaging does she need?

History of Present Illness

A 14 year old female with a history of prior meningitis and chronic sinusitis presents to the emergency department (ED) with several days of headaches and body aches. Earlier today, she vomited several times after breakfast and seemed confused. Her parents deny any sick contacts at home and report that she has otherwise been healthy. They deny any focal neurological deficits or seizure-like activity. Currently, the patient reports headache, neck stiffness, and light sensitivity.

Her parents report that about one year prior, she had a similar presentation to the ED and was ultimately found to have Streptococcus pneumonia sepsis and meningitis. She had a prolonged hospital course with IV antibiotic treatment but was ultimately discharged home without any residual deficits. Workup for the cause of her meningitis was negative, and thus was presumed to be community-acquired. Of note, she has had several years of sinusitis and intermittent clear drainage from her nose. Her parents note that every time she leans forward (e.g. brushing her teeth), she complains of nose stuffiness and a weird taste in her mouth.