10-17-2007, 07:55 PM
A 72-year-old man comes to the clinic because of a 4-month history of intermittent headaches. He has no prior history of significant headaches. He describes the pain as unilateral, always on the right, generally located in the temporal region. On his review of systems, he complains of some pain and stiffness in his neck, shoulders, and hips, which has also come on in the past few months. Furthermore, he has noticed an unusual pain and tiredness in his jaw near the end of meals. His temperature is 37.2 C (99 F), blood pressure is 122/78 mm Hg, pulse is 62/min, and respirations are 16/min. His pupils are equally round and reactive to light, and his extraocular movements are normal. Visual acuity is 20/30, which is stable for him. The remainder of his neurologic examination is unremarkable. Laboratory studies show an erythrocyte sedimentation rate (ESR) of 124 seconds. Treatment should be instituted immediately to prevent
A. death from further intracranial hemorrhage
B. death from metastatic tumor
C. death from uncal herniation due to mass effect
D. progressive visual loss
E. severe morbidity from a large embolic stroke
A. death from further intracranial hemorrhage
B. death from metastatic tumor
C. death from uncal herniation due to mass effect
D. progressive visual loss
E. severe morbidity from a large embolic stroke