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Severe headache as a presenting complaint in sigmoid sinus thrombosis complicated by functional overlay.

Chaudhary P, Banwari G, Parikh N, Gandhi H - Ind Psychiatry J (2015 Jan-Jun)

Bottom Line: The treating neurophysician concluded that symptoms could no longer be accounted for by the organic condition.Overt and covert psychosocial stressors were found to be present in a detailed psychological exploration.Thus, functional overlay can complicate the clinical picture in a severe organic condition and may require active psychiatric intervention over and above medical treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College and Sheth Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.

ABSTRACT
An otherwise serious and potentially fatal organic condition may present with a co-existing strong functional component. We encountered a female patient who presented with bouts of severe headache over the occipital region, associated with blurring of vision. Initially, non-contrast computed tomography (CT) scan (Brain) showed normal study, and she was deemed as having functional symptoms. Later, magnetic resonance imaging (MRI) (Brain) showed filling defect in right sigmoid sinus and magnetic resonance (MR) venography confirmed right sigmoid sinus thrombosis. On adequate anticoagulation, she did not improve and still had bouts of severe headache, although no longer associated with impaired vision. The treating neurophysician concluded that symptoms could no longer be accounted for by the organic condition. Overt and covert psychosocial stressors were found to be present in a detailed psychological exploration. Psychological intervention effectively controlled the headache. Thus, functional overlay can complicate the clinical picture in a severe organic condition and may require active psychiatric intervention over and above medical treatment.

No MeSH data available.


Related in: MedlinePlus

Non-contrast CT scan (Brain) showing normal study
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Figure 1: Non-contrast CT scan (Brain) showing normal study

Mentions: Mrs. A, a 30-year-old female, presented in psychiatry outpatient department (OPD) with complaint of recurrent bouts of severe headache over the occipital region on a background of continuous generalized dull aching headache which had set in over a period of 5 days. The severe bouts were not preceded by any sensory or motor changes; neither were they associated with nausea, vomiting, lacrimation, photophobia, phonophobia, giddiness, or visual disturbance. There was no relief reported with the multiple analgesics taken, which included Nonsteroidal anti-inflammatory drugs, caffeine, and ergots. Her primary consultation was with a physician at a tertiary care center where she underwent complete blood counts, thyroid, renal and hepatic function tests, random blood sugar test, and non-contrast computed tomography (CT) scan (Brain) [Figure 1], all of which were within the normal range. Also, an apparent excess of facial grimacing gave the impression that she was exaggerating the symptom. Hence, a psychiatric referral was made considering the headaches to be psychogenic in origin.


Severe headache as a presenting complaint in sigmoid sinus thrombosis complicated by functional overlay.

Chaudhary P, Banwari G, Parikh N, Gandhi H - Ind Psychiatry J (2015 Jan-Jun)

Non-contrast CT scan (Brain) showing normal study
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4525438&req=5

Figure 1: Non-contrast CT scan (Brain) showing normal study
Mentions: Mrs. A, a 30-year-old female, presented in psychiatry outpatient department (OPD) with complaint of recurrent bouts of severe headache over the occipital region on a background of continuous generalized dull aching headache which had set in over a period of 5 days. The severe bouts were not preceded by any sensory or motor changes; neither were they associated with nausea, vomiting, lacrimation, photophobia, phonophobia, giddiness, or visual disturbance. There was no relief reported with the multiple analgesics taken, which included Nonsteroidal anti-inflammatory drugs, caffeine, and ergots. Her primary consultation was with a physician at a tertiary care center where she underwent complete blood counts, thyroid, renal and hepatic function tests, random blood sugar test, and non-contrast computed tomography (CT) scan (Brain) [Figure 1], all of which were within the normal range. Also, an apparent excess of facial grimacing gave the impression that she was exaggerating the symptom. Hence, a psychiatric referral was made considering the headaches to be psychogenic in origin.

Bottom Line: The treating neurophysician concluded that symptoms could no longer be accounted for by the organic condition.Overt and covert psychosocial stressors were found to be present in a detailed psychological exploration.Thus, functional overlay can complicate the clinical picture in a severe organic condition and may require active psychiatric intervention over and above medical treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College and Sheth Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.

ABSTRACT
An otherwise serious and potentially fatal organic condition may present with a co-existing strong functional component. We encountered a female patient who presented with bouts of severe headache over the occipital region, associated with blurring of vision. Initially, non-contrast computed tomography (CT) scan (Brain) showed normal study, and she was deemed as having functional symptoms. Later, magnetic resonance imaging (MRI) (Brain) showed filling defect in right sigmoid sinus and magnetic resonance (MR) venography confirmed right sigmoid sinus thrombosis. On adequate anticoagulation, she did not improve and still had bouts of severe headache, although no longer associated with impaired vision. The treating neurophysician concluded that symptoms could no longer be accounted for by the organic condition. Overt and covert psychosocial stressors were found to be present in a detailed psychological exploration. Psychological intervention effectively controlled the headache. Thus, functional overlay can complicate the clinical picture in a severe organic condition and may require active psychiatric intervention over and above medical treatment.

No MeSH data available.


Related in: MedlinePlus