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Recurrent orogenital ulcers with papilloedema and headaches
  1. M A Mahyoub Abbas,
  2. R Cotta,
  3. W Rashid
  1. Conquest Hospital, Hastings, Sussex, UK
  1. Correspondence to:
 Dr M A Mahyoub Abbas, Department of Radiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK;
 maf.abbas{at}doctors.org.uk

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Answers on p 57.

A 33 year old man with a past history of recurrent orogenital ulcers, generalised arthritis, eye inflammation, and an episode of deep vein thrombosis presented with a three day history of worsening headaches not responding to simple analgesia.

On examination he was pyrexial with a temperature of 38°C. Neurological examination showed no signs of meningism or any focal neurological deficit, but fundus examination showed papilloedema. Other systemic examinations were unremarkable.

Initial investigations including full blood count, urea and electrolytes, chest radiography, and urinalysis were normal. Erythrocyte sedimentation rate was 15 mm/hour and C reactive protein was less than 7 mg/l. In view of the fundal findings and headaches, the patient had unenhanced computed tomography of his brain (see fig 1).

Figure 1

Unenhanced computed tomogram of brain.

QUESTIONS

(1) What is the initial diagnosis?

(2) What does the unenhanced computed tomogram of the brain show?

(3) What probable complication of the initial diagnosis has occurred?

(4) What further investigation will you do to confirm the complication?

(5) What is the treatment of this complication?

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