Endgames Case report

Headache and drowsiness in a 22 year old student

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1481 (Published 24 September 2008) Cite this as: BMJ 2008;337:a1481
  1. Hon Man Jor, fixed term specialty training appointment in core medical training1,
  2. Harry R Dalton, consultant gastroenterologist and honorary senior lecturer12
  1. 1Cornwall Gastrointestinal Unit, Royal Cornwall Hospital, Truro TR1 3LJ
  2. 2Peninsula College of Medicine and Dentistry, Royal Cornwall Hospital
  1. Correspondence to: H R Dalton harry.dalton{at}rcht.cornwall.nhs.uk

    A 22 year old female medical student presented as an emergency with headache and drowsiness. She shared a flat with three other students, all of whom were well, and who found her in bed after she failed to turn up for lectures. She had no relevant medical history and was well the day before. The only drug she takes is the oral contraceptive pill.

    On examination she was flushed and drowsy, afebrile, and had no skin rash. Her pulse was 100 (sinus rhythm), blood pressure was 120/80 mm Hg, the Glasgow coma score was 11/15 (localising pain, inappropriate speech, eye opening in response to speech), and pulse oximetry showed an oxygen saturation on air of 98%. Her blood gases were as follows: arterial blood gas on air pH 7.35 (normal range 7.35-7.45), partial pressure of oxygen (pO2) 8.2 kPa (>10.6 kPa), partial pressure of carbon dioxide (pCO2) 5.8 kPa (4.7-6 kPa), bicarbonate ions 24 mmol/l (24-28 mmol/l). The rest of the examination, including a detailed neurological examination and fundoscopy, was normal.

    Questions

    • 1. What is the diagnosis?

    • 2. How is the diagnosis confirmed?

    • 3. What is the treatment?

    Answers

    Short answers

    • 1. Carbon …

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