A 29-year-old woman, gravida 1 para 1, is evaluated in the emergency department for a headache. Three days ago, she had an uncomplicated vaginal delivery with neuraxial anesthesia. This morning, the patient developed an occipital headache that has not improved with acetaminophen. The headache has become progressively worse, and the patient cannot sit without becoming nauseated and vomiting. The patient has no chronic medical conditions and does not use tobacco, alcohol, or illicit drugs. Temperature is 36.7 C (98.1 F), blood pressure is 162/96 mm Hg, pulse is 98/min, and respirations are 18/min. On examination, heart sounds are normal with no rubs or murmurs, and the lungs are clear to auscultation. Cranial nerves are intact and deep tendon reflexes are 3+. There is 5/5 strength in the right lower extremity and 3/5 strength in the left. Which of the following is the best next step in management of this patient?

Question

A 29-year-old woman, gravida 1 para 1, is evaluated in the emergency department for a headache.  Three days ago, she had an uncomplicated vaginal delivery with neuraxial anesthesia.  This morning, the patient developed an occipital headache that has not improved with acetaminophen.  The headache has become progressively worse, and the patient cannot sit without becoming nauseated and vomiting.  The patient has no chronic medical conditions and does not use tobacco, alcohol, or illicit drugs.  Temperature is 36.7 C (98.1 F), blood pressure is 162/96 mm Hg, pulse is 98/min, and respirations are 18/min.  On examination, heart sounds are normal with no rubs or murmurs, and the lungs are clear to auscultation.  Cranial nerves are intact and deep tendon reflexes are 3+.  There is 5/5 strength in the right lower extremity and 3/5 strength in the left.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

The Answer is B

A 29-Year-Old Woman, Gravida 1 Para 1, Is Evaluated in the Emergency