title: Aches, pains and headache: an unusual combination of hypothyroidism, vitamin D deficiency, cervical radiculopathy and cortical vein sinus thrombosis.
abstract: A young obese woman was admitted with vague aches and pains, including a headache. At first a provisional diagnosis of depression/myofacial pain syndrome was considered. Later, on evaluation, she was diagnosed to have hypothyroidism and vitamin D deficiency. One week into treatment, her neck pain and headache got worse. Examination of the fundus showed tortuous vessels, papilloedema and intraretinal haemorrhages. MR venogram of the brain was performed, which revealed the presence of thrombosis in the left transverse sinus, left sigmoid sinus and left internal jugular vein. This report is an unusual presentation of neuropsychiatric symptoms in a patient where overlapping diagnoses confound the clinical picture and test the clinical acumen of the physician. A careful history followed by a focused clinical examination and evaluation will help to delineate potential confounders. The report further highlights the importance of clinical medicine even in this era of 'investigative medicine'.
authors.affiliation: Department of Medicine, Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam District, Kerala, India.
authors.forename: Abraham M
authors.initials: AM
authors.lastname: Ittyachen
authors.affiliation: Department of Medicine, Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam District, Kerala, India.
authors.forename: Anuroopa
authors.initials: A
authors.lastname: Vijayan
authors.affiliation: Department of Neurology, Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam District, Kerala, India.
authors.forename: Pratheep
authors.initials: P
authors.lastname: Kottam
authors.affiliation: Department of Medicine, Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam District, Kerala, India.
authors.forename: Appu
authors.initials: A
authors.lastname: Jose
mesh_terms: D005260:Female; D006261:Headache; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D010146:Pain; D010211:Papilledema / Q000209:etiology; D011843:Radiculopathy / Q000175:diagnosis*; D012166:Retinal Hemorrhage / Q000209:etiology; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis*; D014808:Vitamin D Deficiency / Q000175:diagnosis*; D055815:Young Adult