Case 17 (click here for help)
A 20 year-old college student comes to student health, which you are covering on a primary care
elective, during summer session with headache fever, and stiff neck for several days. She thought she was getting a cold, but for the past 36 hours has had a severe headache, worse with bright lights, and a stiff neck. She volunteers that she has had occasional migraines, but that this is a different kind of headache. She had been feeling well previously; her only medications are acetaminophen for headache.
On examination, she appears uncomfortable, but not toxic, with temperature 38 C, three finger-breadth meningismus and no rash. She is alert, conversant, and provides an excellent history.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.

2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these are less likely.
3) What additional information (history, exam, laboratory or other studies) would you like to obtain?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you monitor her condition and its treatment? What is the prognosis?

Case 17
A 20 year-old college student comes to student health, which you are covering on a primary care
elective, during summer session with headache fever, and stiff neck for several days. She thought she was getting a cold, but for the past 36 hours has had a severe headache, worse with bright lights, and a stiff neck. She volunteers that she has had occasional migraines, but that this is a different kind of headache. She had been feeling well previously; her only medications are acetaminophen for headache.
On examination, she appears uncomfortable, but not toxic, with temperature 38 C, three finger-breadth meningismus and no rash. She is alert, conversant, and provides an excellent history.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these are less likely.
3) What additional information (history, exam, laboratory or other studies) would you like to obtain?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor her condition and its treatment? What is the prognosis?A 20 year-old college student with headache (click here for help)

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