Clinical reasoning: a 48-year-old woman with recurrent headache, transient neurologic symptoms, and CSF pleocytosis.

Antonios Kerasnoudis, MD Ralf Gold, MD Min-Suk Yoon, MD SECTION 1 A 48-year-old woman was admitted to our department with recurrent episodes of throbbing right parietal headache lasting for hours. The patient was afebrile and neurologic examination disclosed no signs of meningeal irritation or papilledema. Blood pressure (BP) levels and heart rate were normal ( 140/90 mm Hg, 70 bpm) on repeat measurements. Before onset of headache she experienced a transient sensory deficit on the right half of her body. The patient reported having the first episode of headache 2 weeks prior to admission, while on a trip in Colombia. The pain was of pulsating nature and was aggravated by physical activity. She occasionally reported that the headache was accompanied by nausea, vomiting, allodynia of the skin of the head, and phonophobia and photophobia. The headache attacks were not preceded by any symptoms of aura and were relieved by nonsteroid inflammatory drugs followed by periods of rest and sleep. The headache episodes lasted less than 24 hours and the patient recovered completely from her symptoms. The patient had no history of headaches and no family history of migraine.