Chief Complaint
A 32-year-old female came to her local doctor’s office with severe headaches, vertigo, and blurred vision.
Relevant Past Medical History
Abigail S. is a 32-year-old female from Troy, MI. She is a loan analyst for a mortgage company. She runs half marathons several times a year and regularly practices yoga.
She has come to her primary care provider citing severe and progressively worsening headaches, occurring over the past two months, with a more recently developed problem of blurred vision and vertigo. She says she has also begun to feel “foggy” and “unusually tired.” Past medical history is unremarkable. The patient does not smoke, and drinks socially 1-2 times a month. The patient reports no ongoing medical conditions or use of medication. Family history unremarkable and negative for neurological or cardiovascular disease.
Relevant Physical Exam Findings
Patient was not in acute distress and reported no recent trauma. All vital signs were within normal range, and examination of heart and lungs were normal. Neurological exam was normal, with intact mental status, language, and comprehension. Reflexes, strength, and sensation were all normal.
Relevant Diagnostic Testing and Imaging Data
Neuroimaging stack used with Creative Commons permission from Radiopaedia.org: Case courtesy of Ayaz Hidayatov, rID: 54853
Case with hidden diagnosis for student version: https://radiopaedia.org/cases/56e0364957fe7f36a8de894f98f2a9bf?lang=us
Full case: https://radiopaedia.org/cases/aqueductal-stenosis-due-to-membranous-occlusion?lang=us
Final Diagnosis
Non-communicating hydrocephalus due to aqueductal stenosis
anatomical basis of clinical presentation
- Severe headaches, vertigo, and blurred vision are due to increased intracranial pressure from the CSF accumulating within the lateral and third ventricles.
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