Headache and abdominal pain in a young woman D. Luke Glancy, MD, and Prashanthi Atluri, MD
A
19-year-old woman with a history of hydrocephalus treated at age 2 weeks with a ventriculoperitoneal shunt, last revised at age 15, presented to the emergency department with 2 weeks of diffuse abdominal pain and increasing girth and 2 days of right frontal headache relieved by lying supine. She initially had nausea and vomiting, which resolved after several days, leaving her with anorexia. There had been no fever or change in her bowel movements. Her blood pressure was 101/58 mm Hg, and her neurological examination was normal. Figure. Electrocardiogram recorded in a young woman with headache and abdominal pain. See text for explication. An abdominal ultrasound examination showed extensive ascites and normal ovaries and uterus. Computed tomography increased intracranial pressure, in the absence of high blood revealed a cystic accumulation of fluid in the lower abdomen. pressure this cannot be called Cushing’s phenomenon. In Because of a slow irregular pulse, an electrocardiogram was fact, no definite abnormality is noted in the electrocardiorecorded and showed sinus bradycardia and arrhythmia with gram shown here. Sinus bradycardia and arrhythmia with occasional junctional escape complexes (Figure). occasional junctional escape complexes are not rare in healthy At craniotomy, the proximal catheter from the fourth venyoung adults. Also, the T-wave inversion in leads V1 to V3 is tricular Dandy-Walker cyst was found to be obstructed and fairly common in normal young women. was replaced. The distal catheter was then replaced. Postopera1. Spennato P, Mirone G, Nastro A, Buonocore MC, Ruggiero C, Trischitta tively, the patient’s abdominal pain resolved, and her headache V, Aliberti F, Cinalli G. Hydrocephalus in Dandy-Walker malformation. decreased. Childs Nerv Syst 2011;27(10):1665–1681. The Dandy-Walker deformity is a congenital malformation 2. Cushing H. Concerning a definite regulatory mechanism of the vasomotor that occurs in approximately 1 in 20,000 newborns. Noncomcentre which controls blood pressure during cerebral compression. Bull municating hydrocephalus is often part of the syndrome and Johns Hopkins Hosp 1901;12:290–292. is usually treated with ventriculoperitoneal shunting, as in this patient (1). One hundred and fifteen years ago, Harvey Cushing, Dandy’s and Walker’s predecessor in neurosurgery at Johns From the Section of Cardiology, Department of Medicine, Louisiana State Hopkins, described high blood pressure, bradycardia, and University Health Sciences Center, New Orleans, Louisiana. terminally a slow respiratory rate in patients with increased Corresponding author: D. Luke Glancy, MD, 1203 West Cherry Hill Loop, Folsom, intracranial pressure (2). Although this patient may have had LA 70437 (e-mail: [email protected]).
Proc (Bayl Univ Med Cent) 2016;29(3):305
305
A
19-year-old woman with a history of hydrocephalus treated at age 2 weeks with a ventriculoperitoneal shunt, last revised at age 15, presented to the emergency department with 2 weeks of diffuse abdominal pain and increasing girth and 2 days of right frontal headache relieved by lying supine. She initially had nausea and vomiting, which resolved after several days, leaving her with anorexia. There had been no fever or change in her bowel movements. Her blood pressure was 101/58 mm Hg, and her neurological examination was normal. Figure. Electrocardiogram recorded in a young woman with headache and abdominal pain. See text for explication. An abdominal ultrasound examination showed extensive ascites and normal ovaries and uterus. Computed tomography increased intracranial pressure, in the absence of high blood revealed a cystic accumulation of fluid in the lower abdomen. pressure this cannot be called Cushing’s phenomenon. In Because of a slow irregular pulse, an electrocardiogram was fact, no definite abnormality is noted in the electrocardiorecorded and showed sinus bradycardia and arrhythmia with gram shown here. Sinus bradycardia and arrhythmia with occasional junctional escape complexes (Figure). occasional junctional escape complexes are not rare in healthy At craniotomy, the proximal catheter from the fourth venyoung adults. Also, the T-wave inversion in leads V1 to V3 is tricular Dandy-Walker cyst was found to be obstructed and fairly common in normal young women. was replaced. The distal catheter was then replaced. Postopera1. Spennato P, Mirone G, Nastro A, Buonocore MC, Ruggiero C, Trischitta tively, the patient’s abdominal pain resolved, and her headache V, Aliberti F, Cinalli G. Hydrocephalus in Dandy-Walker malformation. decreased. Childs Nerv Syst 2011;27(10):1665–1681. The Dandy-Walker deformity is a congenital malformation 2. Cushing H. Concerning a definite regulatory mechanism of the vasomotor that occurs in approximately 1 in 20,000 newborns. Noncomcentre which controls blood pressure during cerebral compression. Bull municating hydrocephalus is often part of the syndrome and Johns Hopkins Hosp 1901;12:290–292. is usually treated with ventriculoperitoneal shunting, as in this patient (1). One hundred and fifteen years ago, Harvey Cushing, Dandy’s and Walker’s predecessor in neurosurgery at Johns From the Section of Cardiology, Department of Medicine, Louisiana State Hopkins, described high blood pressure, bradycardia, and University Health Sciences Center, New Orleans, Louisiana. terminally a slow respiratory rate in patients with increased Corresponding author: D. Luke Glancy, MD, 1203 West Cherry Hill Loop, Folsom, intracranial pressure (2). Although this patient may have had LA 70437 (e-mail: [email protected]).
Proc (Bayl Univ Med Cent) 2016;29(3):305
305
