Symptomtext
CHIEF COMPLAINT Headache HISTORY OF PRESENT ILLNESS: Patient is a 42 y.o. female with medical comorbidities significant for hyperlipidemia (not on medication), migraine with aura (takes sumatriptan), depression who presents with chief complaint of left-sided pulsatile headache and dizziness of 1 day duration. Yesterday she developed sudden onset tinnitus of the left ear and a pulsatile headache above and below the left ear. She states that these symptoms were very different than her migraine with aura, as it was not associated with photophobia, phonophobia, or nausea/vomiting. She took her sumatriptan after which her symptoms briefly improved but did not resolve. Also endorses associated dizziness which she describes as "feeling like you are on a boat and unsteady." Denies any recent fever, chills, or respiratory symptoms. She was concerned that she might be having a stroke, so she decided to present to the ED for further workup. Workup in the ED significant for PCR-positive COVID-19. Electrolytes and complete blood count within normal limits. CT head non-contrast without acute intracranial abnormality. CTA head/neck significant for nonocclusive thrombus in the left sigmoid venous sinus, but patent intracranial nd cervical carotid and vertebral circulations. She takes oral contraceptive pills and is a non-smoker. She has a longstanding history of migraine with aura for which she takes sumatriptan. Denies any known COVID-19 exposure or symtpoms. She did have a COVID-19 infection diagnosed in January of 2021, and received two doses of the Pfizer vaccine (March and April 2021).