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CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 10-2016. A 22-Year-Old Man with Sickle Cell Disease, Headache, and Difficulty Speaking.

Dr. Todd M. Herrington (Neurology): A 22-year-old right-handed man was admitted to this hospital because of the acute onset of headache and difficulty speaking. The patient had been well until approximately noon on the day of admission, when a dull, diffuse headache developed; the pain gradually increased in severity until he rated it at 10 on a scale of 0 to 10, with 10 indicating the most severe pain. He took ibuprofen, and the headache improved but did not resolve. Between 6 and 7 p.m., he smoked marijuana. At approximately 7 p.m., a friend noted that the patient suddenly leaned forward and held his head in his hands. He then stood and was noted to have heavy breathing and unintelligible speech. He appeared to be frustrated by his inability to communicate. His friends brought him to the emergency department of this hospital; he arrived at 7:43 p.m. On arrival, the patient was unable to name the place or date. He reported that he felt confused and had difficulty thinking of and saying words; he rated the headache at 3 out of 10. He reported no recent trauma, neck pain, fever, chills, chest pain, or upper respiratory or gastrointestinal symptoms. He had sickle cell anemia, which was monitored at another hospital. It was associated with infrequent crises, the most recent of which had occurred more than a year earlier; his most recent blood transfusion had occurred 22 months before this evaluation. He had been hospitalized for pain crises in the past and for the acute chest syndrome once, 6 years earlier. He had had recurrent headaches during the past 15 months; evaluation at another hospital had revealed multiple intracranial aneurysms, which were reportedly stable on serial imaging studies. He had undergone a cholecystectomy at 12 years of age. His medications included ibuprofen, as needed for headaches, and folic acid. He had no known allergies. He was a student and lived with a friend. He smoked marijuana regularly, drank alcohol infrequently, and did not smoke tobacco or use other illicit drugs. His parents were of African-American ancestry. His biologic father’s medical history was not known; his mother and two of his three half siblings had the sickle cell trait, his mother and her half brother From the Departments of Neurology (F.S.B., J.D.S.), Radiology (J.M.R.), and Pathology (R.S.M.), Massachusetts Gen‐ eral Hospital, and the Departments of Neurology (F.S.B., J.D.S.), Radiology (J.M.R.), and Pathology (R.S.M.), Harvard Medical School — both in Boston.