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MCQ: Headache with subconjunctival Haemorrhage, Cause?

1.

A 22 yr old woman presents to her general practitioner with a 12hour history of diarrhoea, malaise and severe bifrontal aching headache. On examination there is conjunctival haemorrhages.

What is the most likelydiagnosis? 1. benignintracranial hypertension2. clusterheadaches3. meningitis4. migraine5. space-occupyinglesionwould anyone have an idea what the correct answer is? I am thinking benign intracranial HTN, because its associated with conjunctival haemorrhage but the Diarrhea and malaise makes me think it could also be menningitis
Benign intercranial hypertension does not give you diarrhoea or malaise and does not come on acutely over 12 hours. When answering MCQs like this (and in real life) you can't discard the other features just to make a convenient diagnosis.
Reply 2
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Cannula
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true I agree with your point, I can't seem to find a diagnosis which incorporates all the signs and symptoms given though, it seems like an infectious picture, I never really put diarrhea with menningits but it is the only infectious option.

Does anyone have any suggestions
Diarrhoea and meningitis are frequent associations.
Reply 4
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Cannula
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I see, thanks! what about the subconjunctival haemorrage is that common with mennigits?
Blood clot?
Original post by Cannula
I see, thanks! what about the subconjunctival haemorrage is that common with mennigits?
Common no, but it also doesn't fit with the other diagnoses. Space occupying lesion wouldn't give such a short history with diarrhoea. Classical migraine localises to one side of the head (although atypical migraine does affect both sides, diarrhoea is not a feature) and should terminate before 12 hours. Inter cranial hypertension similarly doesn't have the associated features described. Cluster headache is unilateral, lasts up to 3 hours, and is often described as sharp instead of aching. Idiopathic intracranial hypertension wouldn't give conjunctival haemorrhage or diarrhoea, although malaise is common. Meningitis is thus the only suitable answer.
Original post by Cannula
I see, thanks! what about the subconjunctival haemorrage is that common with mennigits?


Could be underlying DIC secondary to the meningitis.
Reply 8
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Cannula
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Original post by Marshall Taylor
Blood clot?


Original post by Spencer Wells
Common no, but it also doesn't fit with the other diagnoses. Space occupying lesion wouldn't give such a short history with diarrhoea. Classical migraine localises to one side of the head (although atypical migraine does affect both sides, diarrhoea is not a feature) and should terminate before 12 hours. Inter cranial hypertension similarly doesn't have the associated features described. Cluster headache is unilateral, lasts up to 3 hours, and is often described as sharp instead of aching. Idiopathic intracranial hypertension wouldn't give conjunctival haemorrhage or diarrhoea, although malaise is common. Meningitis is thus the only suitable answer.


Original post by Etomidate
Could be underlying DIC secondary to the meningitis.


Ok thanks everyone! its helpful to be able to see what your reasoning is! yes, another possible explanation I can think of is if she has been vomitting with the meningitis which causes the haemorrhage

Cheers!
Original post by Spencer Wells
Common no, but it also doesn't fit with the other diagnoses. Space occupying lesion wouldn't give such a short history with diarrhoea. Classical migraine localises to one side of the head (although atypical migraine does affect both sides, diarrhoea is not a feature) and should terminate before 12 hours. Inter cranial hypertension similarly doesn't have the associated features described. Cluster headache is unilateral, lasts up to 3 hours, and is often described as sharp instead of aching. Idiopathic intracranial hypertension wouldn't give conjunctival haemorrhage or diarrhoea, although malaise is common. Meningitis is thus the only suitable answer.


Lol, that sounds like one of those "model answers" in an online/printed MCQ mock quiz.

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