[56F] Experiencing cognitive difficulties and various neurological symptoms

Patient Description

A 56-year-old female presents with a 6-8 week history of cognitive difficulties, including trouble putting thoughts together, keeping up with conversations, and expressing thoughts verbally, worsening at night. She reports a persistent headache, rated 8-10 in severity, located at the back of the head and sometimes escalating to a migraine under stress. Neck pain, rated 7-10, presents mostly on the right side with stiffness, soreness, and occasional shooting pains, which began prior to but was exacerbated by a fall on ice in January. The patient experiences constant up/down double vision and blurry vision since the fall, preventing her from driving. Moderate to severe sensitivity to light has been noted for 6-8 weeks. Nausea is persistent, especially after eating, and intermittent numbness occurs in the extremities. Speech is occasionally slurred. The patient has a medical history of a heart attack 5 years ago and is currently on multiple medications, including Atorvastatin, Escitalopram, Metoprolol, Clopidogrel, Amlodipine, Aspirin, Omeprazole, Methocarbam, and Butal/Acetamn/CF, as well as CoQ10, Vitamin C, and a multivitamin supplement. No known allergies to current medications, but has reported allergies to Sulfa and Compazine.

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Arora's Assessment

What might be happening

Based on the information you've provided, several conditions could be causing your symptoms:

  • Migraines: These are severe headaches often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light. They can cause cognitive difficulties, including trouble with memory and concentration. The fact that you have a history of migraines and that your father also had migraines suggests this could be a possibility.

    • Treatment typically involves medication to relieve symptoms and prevent future migraines. Lifestyle changes, such as stress management and regular exercise, can also help.
  • Post-Concussion Syndrome: This condition can occur after a head injury, such as the fall you experienced. Symptoms can include headaches, dizziness, cognitive difficulties, and changes in vision.

    • Treatment typically involves rest and symptom management. Cognitive therapy may also be beneficial.
  • Cervicogenic Headache: This is a type of headache caused by issues in the neck, often due to injury or strain. The pain is usually felt in the back of the head and may be accompanied by neck pain and stiffness.

    • Treatment typically involves physical therapy, medication, and possibly nerve blocks.
  • Medication Overuse Headache: This is a type of headache that can occur when pain medication is used too frequently. It's possible that your use of Tylenol could be contributing to your headaches.

    • Treatment involves reducing or stopping the overused medication under the guidance of a healthcare provider.
  • Giant Cell Arteritis: This is an inflammation of the arteries in the head and neck. It can cause headaches, jaw pain, vision problems, and cognitive difficulties. It's more common in people over 50.

    • Treatment typically involves high-dose corticosteroids.

Please note that this is not an exhaustive list and other conditions could also be causing your symptoms.

What you can do

Given the severity and persistence of your symptoms, it's important to seek medical attention as soon as possible. Here are some steps you can take:

  1. Schedule an appointment with your primary care provider. They can perform a physical examination and possibly order tests to help determine the cause of your symptoms.
  2. If you have a neurologist, consider scheduling an appointment with them as well.
  3. Keep a symptom diary. Note when your symptoms occur, their severity, and any potential triggers. This can help your healthcare provider in their assessment.
  4. Continue to take your prescribed medications as directed by your healthcare provider.
  5. Try to rest and avoid activities that worsen your symptoms.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Sudden, severe headache
  • Sudden loss of vision or double vision
  • Sudden difficulty speaking or understanding speech
  • Sudden weakness or numbness on one side of your body
  • Sudden dizziness, loss of balance, or difficulty walking

Remember, I'm an AI and this advice is based on the information you've provided. It's important to consult with a healthcare provider for a formal diagnosis and treatment.

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9 mo ago


People Also Ask


What are the common symptoms of post-concussion syndrome?

Post-concussion syndrome can include symptoms such as headaches, dizziness, cognitive difficulties, changes in vision, and sometimes emotional or behavioral changes. These symptoms can persist for weeks or months after the initial head injury.


How can migraines affect cognitive function?

Migraines can affect cognitive function by causing difficulties with memory, concentration, and processing speed. These cognitive symptoms can be exacerbated by the pain and other symptoms of a migraine, such as nausea and sensitivity to light.


What is cervicogenic headache and how is it treated?

Cervicogenic headache is a type of headache that originates from issues in the neck, such as injury or strain. It typically causes pain in the back of the head and may be accompanied by neck pain and stiffness. Treatment often involves physical therapy, medication, and sometimes nerve blocks.


Can medication overuse cause headaches and how can it be managed?

Medication overuse headache occurs when pain relief medications are used too frequently, leading to a cycle of chronic headaches. Management involves reducing or stopping the overused medication under medical supervision, and sometimes using alternative treatments to manage pain.


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