A Real Headache

Cardiovascular System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"Headache is a very common presenting complaint and may be secondary to both benign and sinister causes. Features suggestive of a sinister eitiology include early morning worsening of the headache, worsening with coughing or sneezing, or an acute onset severe headache.\n\nWhile this patient has not manifested any such symptoms, the fact that this is a new onset headache and the progressive worsening of symptoms indicate that further evaluation is required.\n\nThe examination reveals partial ptosis, miosis and enopthalmos - findings suggestive of Horner\u0027s syndrome.\n\nHorner\u0027s syndrome occurs following damage to the cervical sympathetic pathway. Loss of sympathetic innervation of the superior tarsal muscle leads to partial ptosis, while anhidrosis (decreased sweating of the affected half of the face), enopthalmos (sunken eye) and miosis (pupillary constriction secondary to unopposed parasympathetic innervation) are also seen.\n\nThe sympathetic outflow arises at the level of T1. From here, the c"}]}

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