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Case 28
A 64 year-old woman seeks medical attention for headaches that began 2 months ago. They are
bitemporal and last throughout the day. There is no associated nausea, vomiting, sensory, or visual
symptoms, but she feels tired and has noticed some aching in her arms and legs. Sometimes when she
chews, she develops aching in the left side of her jaw. She has an appointment to see her dentist next
week. As you speak to her, you notice that she appears uncomfortable and chronically ill.
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?
What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses
for one medication you might prescribe, along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about her condition and about any proposed
therapy
Case 28
A 64 year-old woman seeks medical attention for headaches that began 2 months ago. They are
bitemporal and last throughout the day. There is no associated nausea, vomiting, sensory, or visual
symptoms, but she feels tired and has noticed some aching in her arms and legs. Sometimes when she
chews, she develops aching in the left side of her jaw. She has an appointment to see her dentist next
week. As you speak to her, you notice that she appears uncomfortable and chronically ill.
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?
What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses
for one medication you might prescribe, along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about her condition and about any proposed
therapy