Severe Occipital Headache And Photophobia
Severe Occipital Headache And Photophobia
A H Ross, registrar, G R C Baker, consultant ophthalmologist, R Martin, consultant neurologist, Q Mohamed, consultant ophthalmologist
Author Affiliations 1Cheltenham General Hospital, Cheltenham GL53 7AN, UK adamross@doctors.ork.uk
A 27 year old man was admitted with severe occipital headache and photophobia. He had no relevant history.
Computed tomography and magnetic resonance imaging showed no abnormality. A subsequent lumbar puncture
was normal. After 24 hours he reported central scotomas in the right eye, and later in his left eye. Ophthalmologists
found bilateral multiple yellow-white subretinal lesions of the posterior pole. He was diagnosed with acute posterior
multifocal placoid pigment epitheliopathy, a common self limiting idiopathic inflammatory disorder. Treatment with
oral steroids expedited recovery. The condition can be associated with meningoencephalitis, which explains this
patient's initial presentation of severe headache.
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Patient consent obtained.
Minerva
Hayfever
was first described by John Bostock in 1819 when he presented a paper on summer catarrh entitled Periodical
Affection of the Eyes and Chest. He wrote that “the sensation becomes converted into what may be characterised as
a combination of the most acute itching and smarting, accompanied with a feeling of small points striking upon or
darting into the ball.” Perhaps unsurprisingly, use of bleeding, purging, blisters, a spare diet, bark (containing
quinine), cold bathing, and various other tonics including opium, mercury, and digitalis was to no avail. The patient
was Bostock himself (Journal of the Royal Society of Medicine 2011;104:237-40, doi:10.1258/jrsm.2010.10k056).
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In Spain, smoking is very common in both men and women, but does quitting differ between the sexes? A secondary
analysis of a cluster randomised trial of motivational counselling and drug therapy found that at one year, the rate of
quitting with six months' continuous abstinence in men (9.4%) was similar to that in women (8.5%, p=0.4). After
adjustment for confounders, women did not have higher odds than men of being an ex-smoker for individuals
presenting at primary care centres (BMC Public Health 2011;11:369, doi:10.1186/1471-2458-11-369).
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Remission of depression in mothers seems to be followed by decreases in their children's problem behaviour and
symptoms over the next year. The favourable effect of mothers' remission on their children's functioning was
observed only in children of early remitters. Psychiatric symptoms decreased significantly only in children of
mothers who remitted and behavioural problems decreased in children of early and later remitters, but not in
children of non-remitting mothers (American Journal of Psychiatry 2011;168:593-602, ajp.psychiatryonline.org).
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The use of documented resuscitation orders in newly admitted medical patients is not clear. An Australian team
propose the widespread use of a scoring system to identify those patients who need their resuscitation status clarified
early in their admission and before clinical deterioration. Their study revealed that within the first 24 hours of
admission, there were no documented discussions for 78% of patients, although as age or a measure of clinical
debility increased, so the number and proportion of patients deemed not for resuscitation also increased (QJM
2011;104:485-8, doi:10.1093/qjmed/hcq241).
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A short animated video in Japanese provided a basic explanation of anaesthetic procedures to patients undergoing
surgery for cancer, including the risks, benefits, and alternatives. In a randomised trial, watching the video helped
patients' understanding of anaesthesia and significantly reduced the interview time with the anaesthetist. Anxiety
levels were the same as in the control group, in which patients did not watch the video (Anesth Analg
2011;112:1314-8,
A H Ross, registrar, G R C Baker, consultant ophthalmologist, R Martin, consultant neurologist, Q Mohamed, consultant ophthalmologist
Author Affiliations 1Cheltenham General Hospital, Cheltenham GL53 7AN, UK adamross@doctors.ork.uk