Published 18 March 2009, doi:10.1136/bmj.b911
Cite this as: BMJ 2009;338:b911

Endgames

Picture Quiz

Postural headache

Omer Ali, foundation year 2, general medicine1, Maithili Srikantha, foundation year 2, general medicine1, Waseem Bhat, fixed term specialty appointment 2, trauma and orthopaedics2, Chika Edward Uzoigwe, fixed term specialty appointment 2, trauma and orthopaedics1

1 Milton Keynes General Hospital, Milton Keynes MK6 5LD , 2 Hull Royal Infirmary, Hull HU3 2JZ

Correspondence to: O Ali omerali@doctors.org.uk

The first 150 words of the full text of this article appear below.

A 50 year old man, with known Marfan’s syndrome, was admitted with a one week history of severe headaches over the top of his skull, neck pain, and daily vomiting. His symptoms were greatly aggravated by standing, but they disappeared when he lay flat. He was systemically well and had no history of trauma. He had undergone an aortic root and metallic valve replacement 13 months previously and was on lifelong warfarin.

On examination he had morphological features consistent with Marfan’s syndrome, including tall stature, pectus carinatum, arachnodactyly, joint hypermobility, and high arch palate. He did not have a fever. He had no neurological deficit, photophobia, or signs of meningism. His blood investigations were unremarkable except for an international normalised ratio of 3.8. Magnetic resonance imaging of the brain and lumbosacral spine was performed (figs 1-3Go Go Go).


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  		Fig 1 T2 weighted magnetic resonance imaging of the brain: axial view

 


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  		Fig . . . [Full text of this article]

 

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Submitted material: Entrust image interpretation to the experts.
Panos Koumellis, et al.
bmj.com, 1 Apr 2009 [Full text]
Entrusting Image Interpretation to Radiologists?
Chika E Uzoigwe, et al.
bmj.com, 15 Apr 2009 [Full text]
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