Headache under evaluation

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A 28 year old male working in a chemical drug company was apparently asymptomatic 5 years back when he was studying MBA then he developed first episode of headache for 2 dayswhich was preceded by blurring of vision, irritability,giddiness,vomiting and headache is of throbbing type , He went to RMP where he was given medication .Pain  got slightly relieved on medication,aggravated in  noisy environment.3 years back he developed similar complaints (2nd episode)when he was working as supervisor in construction work.He felt the triggering fact as smell of chemicals which is from pharmacy company beside his work place.onceagain He went to RMP where headache got slightly relieved due to medication.The episode lasted for 1 day.He developed similar complaints(3rd episode) 1 year back and the episode lasted for 1 day.On Thursday (13-08-2020) at Night 8:00 pm he started developing blurring of vision,vomiting,  Non bilious,giddiness,headache - throbbing type(4th episode).Pain is extending till neck.He went to RMP where he was not able to remember the events properly so he was referred to our hospital due to increasi

ng in severity of headache.He came to our hospital at 11:00Pm with c/o blurring of vision , defective vision in certain area of visual field,vomiting -5 episode , and giddiness.patient complaints of disturbed sleep during the episode,unable to his daily activities during the episode.No history of fever,weight loss,positional head ache,neck stiffnes

Past history:No Hx of D.M,HTN,Jaundice,CKD,CHD ,Asthma,T.B

Past surgical History: Appicendectomy done 10 years back 

Personal History: Diet: Mixed

                               Appetite : adequate 

                               Bowel &bladder:regular 

                                Sleep: Adequate 

                              Addictions:occasionally alcohoholic

Family History:Not significant 

Drug History:Patient is not allergic to any known drugs 

General examination:

Patient is c/c/c moderately built and moderately nourished. 

No pallor, icterus, cyanosis, clubbing,koilonychia, lymphadenopathy, edema.

Vitals:  B.P : 120/80 mmhg 

             P.R : 78 bpm 

            R.R: 14 cpm 

            Spo2: 98% at room air 

Systemic examination:

CNS: Higher mental functions-normal

All cranial nerves intact

Sensory system-intact

Motor system 

                 Rt.        Lt

Bulk UL.    N.        N

         LL.     N.        N

Power UL.  5/5.     5/5

            LL.     5/5.     5/5

Tone. UL.      N.        N 

          LL.        N.        N

Reflexes. 

       Biceps  +3.          +3

       Triceps +3.          +2

        Supinator+2.        +2

        Knee jerk+3.          +3

         Ankle      +2.           +2

      

No cerebellar signs 

CVS

S1 S2 heard

No murmurs 

RESPIRATORY system

Bilateral air entry present

Normal vesicular breath sounds

Trachea central

No added sounds

Shape of chest normal 

Per abdomen

Shape elliptical

Umbilicus central

All quadrants moving equally with respiration

No organomegaly

No local raise of temperature, tenderness

Investigation

mri link

Diagnosis:?Head injury under evaluation

Treatment given:

 1) plenty of I.V fluids 

 2) Tab. Pan 40 mg O.D

 3) Tab. Zofer 4 mg O.D/SOS

 4) Tab . Naproxen 500 mg B.D

  5) B.P, P.R monitoring