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Summary and response to The New York Times – Well article: “Think Like A Doctor: The Quarterback’s Headache.” We present a succinct overview of the case presented in The New York Times article and discuss how medical algorithms can assist in coming up with the correct diagnosis as well as a clinical workup and treatment plan.

A 15-year-old male initially notices a pressure on the top of his head which is exacerbated by bending over. Progressive worsening of his headache ensues and the pain worsens over the next several weeks and gets to the point where he is unable to get out of bed because of photophobia. Visits with his primary care doctor and emergency room yield no diagnostic testing based on the presumption of migraine etiology and likelihood to resolve without further intervention.

After subsequent encounters, the patient’s mother became convinced that there was another cause for his headache and sought further work up. A CT scan revealed a mass in the brain with edema and midline shift. Continued work up gave the diagnosis of a brain abscess with underlying etiology secondary to pulmonary arteriovenous malformation from undiagnosed hereditary hemorrhagic telangiectasia (HHT), also known as Oslo-Weber-Rendu syndrome.

Utilizing medical algorithms, the patient’s primary care physician could have used the Alarm Signs and Symptoms in Headache Indicating Possible Serious Intracranial or Systemic Pathology algorithm to determine that the patient needed to be evaluated more extensively with brain imaging. Other algorithms that can be used in instances of severe headache evaluation available from The Medical Algorithms Company:

Alarm Signs and Symptoms in Migraine Indicating the Need for Additional Testing

Clinical Rules for Identifying a Patient with Acute Headache Who Should Be Evaluated for Subarachnoid Hemorrhage

To aid in intracranial abscess diagnosis, CDC criteria for intracranial infection can be reviewed by the hospitalists and infectious disease team.

When considering hereditary hemorrhagic telangiectasia, medical algorithms such as the Curacao criteria for the diagnosis of hereditary hemorrhagic telangiectasia can be easily accessed via the web or Medal’s iOS or Android mobile app.

A sampling of the algorithms that members of the healthcare team can use to diagnose and treat for patients with HHT:

Genetic loci associated with HHT

Managing a patient with HHT and frequent nosebleeds

When evaluating patients, the ability to easily consult medical algorithms as part of the clinical decision process aids in prompt evaluation and treatment. Whether straightforward conditions or difficult to diagnose cases such as those referenced in The New York Times “Think Like a Doctor” series, the Medical Algorithms Company provides a valuable resource to clinicians.

 


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