So antonia shine 617253 28 year old woman 1,124 white cells 10.6 on blood tests platelets 416 with neutrophils 7.51 white cell count 10.6 hemoglobin a 124 ast awaited note 11/19/2025 beat hcg was 249 a transvaginal ultrasound and first trimester scan but no subsequent scans medications list no repeat medications past medical history mental health read 2024 history of being victim of domestic violence 2017 attended gp today from christmas feeling pressure in the head forehead upper jaw cannot describe exactly the symptoms like pulling in the face and upper teeth vision blurry on and off throughout the day not pregnant not herself irritable no fevers no vision issues not waking up morning or night with a headache full neuro exam normal with the gp and gait normal in my place today oh brilliant come on up where do you want me where do you want me to can you see a bit mhmm I'm rob I'm 1 of the medical students pleasure to meet you how are you yeah I'm fine good I'm glad I read a little bit from your gp about what's going on with your head yeah but tell me all about it in your own words so the week before christmas I had flu mhmm and it was quite bad and then my sinuses were like really affected like towards the end and I had like a bit of a sinus infection so I went to the pharmacy and just like got your usual stuff in pharmacy yeah like sunday yeah and like you know like the the saline rinse and stuff like that the big bottle yeah so did that was it good well it was painful though probably it's gone like that my sinuses are are fine now but I had like boxing day of like upper jaw pain mhmm and I thought it's just probably linked to sinus infection well my sinuses I thought maybe it's just the pressure from that but then it's just then it starts to go to the back of my neck and then like my ears and across my eyes and it's just progressively got worse but it's not all the time that it comes and goes but when it gets bad it gets really bad doesn't it and how I explained it to my partner was mhmm imagine you've a magnet like here mhmm and someone's got a magnet there and they're pulling it it feels like I suppose there's there's like a force sort of pressure mhmm right in the middle of your forehead yeah but then it like behind the backs of my eyes I can feel it in the back of my neck I went to I I drove to exeter to ikea the other day and I had to sit in my calf half an hour before I drove home because of the it was just it's like a force I can't it's like not a pain it's like a pressure mhmm and then we went to we was out it was about 06:00 the other night so it was dark and there was a christmas light and all the lights kept going really blurry it kept saying to him my vision keeps going really blurry mhmm and then that because my vision got has been getting blurry and because of this pain not going it's not getting worse it's not got better it's like it's just the same mhmm but it affects my mood doesn't it because it can when it when comes it on it can come off at 2 hours and I literally have to sit there like sounds awful I can't yeah but because my vision kept going blurry I said to him I'm gonna ring the doctors on 1 and tell me about the vision going blurry can you describe it any more than blurriness so like looking up so that cupboard up there so there's the light like reflects off the cupboard when I look at that like my it blurs like it's not completely completely blurred but it's not it like disfocuses if that makes sense just with lights yeah so when I was driving to the hospital earlier I kept saying to him that people's brake lights were hurting my eyes okay fine and any creams or anything in the eyes lately no nothing like that no fine and are your eyes painful or it's it's your forehead that's painful no it's my it's like the it's like a strain of my eyes it's my forehead it's my nose like I'd say more right here when I tilt my head forward it feels like oh really worse when you tilt your head forward worse but I can feel it like we're doing that I can feel it come in and it's my upper jaw like my teeth as well mhmm it's not the lower it's literally the upper jaw because it's that is like a constant like toothache mhmm but the worst part is is when it comes in here it it feels like something's pulling like I've it's to explain cool sounds awful just like imagine like someone like pulling your face but they're not not do you what I mean pulling it and this has been going on since christmas yeah so it's been it's it's been weeks but it's just not getting better mhmm and now I'm getting a bit like worried as to why it's not getting better because I thought if I had the flu had it quite bad didn't I and I thought maybe it's just my body's taking a while to like clear everything out but then now I'm thinking like why is not this getting better and I have 2 children at home as well so it's stressful when this comes on I'm trying to look after both the kids and I'm sat there like oh I've got a headache and it's just yeah that sounds really tough and any more fevers since no but I've noticed no fine just having like quite a low mood but I don't know it's because I'm miserable because I'm constantly getting these headaches all the time and do you do you think they're migraines does it sound like a migraine or feel like a migraine I've never had a migraine I don't know I've never had vision problems never had a migraine mhmm strange isn't it yeah my friend suffers from migraines and she says she feels quite sick when it comes on I don't have that really experience absolutely and also another thing I've not experienced like a trigger mhmm apart from the bright lights with the the dry so like the brake lights that does hurt my eyes but like I've been like trying to work out if it's like something come like drinking too much caffeine or not drinking enough water I've like been trying to do things I've took like I've and can't figure out like what's causing it mhmm mhmm okay fine interesting isn't it and your gp examined you the nerves in your body and they didn't find anything I don't think they said first they would squeeze hands and stuff okay fine fair enough and is has anyone looked at the back of your eyes no no fine I'm sorry do you mind if we do that I examine the nerves in your face arms and legs and then I'll get my little machine with you in the back of your neck does that sound okay do you mind taking this photo alright okay let me just switch my hands so we'll do this and you're normally pretty fit and well aren't you you don't take any tablets or anything you've got 2 kids now said yeah how old were they 4 weeks out wow and kind of things all these I think if you can stop thank you what are lovely nails yeah think you're telling them mhmm a ballet you're missing 1 1 of them I wouldn't have noticed I'll just borrow your arm and just relax it remember you didn't need anything alright bring your arms palm up like this like a chicken be really strong don't let me move and push down against me lovely like this like a boxer be really strong pull me towards you yep that's good palms up like this that's great be really strong don't let me move you and like this with your fingers played apart and don't let me push your fingers together don't let me push them together just keep them apart that's alright that's great lovely that's great I'm the most you understand I'll just test the reflexes I'm looking to send it there that's alright I do it a few times but it's your first time so it's okay that's lovely I won't draw you on I promise trust me you've got to exercise I won't drop it that's the sensation in your arms feel me touching you here here yeah yeah good let's test the reflexes then so you cut like this lift it over turn it over put it back down here up over down up over down up over down quick and accurate as you can very good same on the other side that's lovely great mind if I be turning your legs yeah and would you mind sitting up on the bed then I can get your legs up and straight is that okay mhmm thank you you you thank back in your eyes I'm gonna feel your hands just need your legs around there I'm just gonna lift your legs up chris if you want mhmm okay alright that's great now test the strength in your legs so just lift this leg off the bed for me don't let me push it down that's great and then send me a little bit I'm gonna do this I'm I'm this me behind us a bit okay sir push me yeah push me down into the yeah that's fine now bend your knees up go push your hands put your hands back towards you turn your hands forward press your forward towards you good push your legs out again it's more like dragging your car push down on your knees and neck and left side and then lift it up so you can that's quite cool just test the reflexes again so you must just relax if you can I've got it pull it back there and your sensation any touching here yeah I think yeah here yep and on the back so if you lift this heel put it towards your knee and slide your heel down to your foot and then lift it up touch my hand and put it back to your knee again yep again kick my hand and back to your knee lovely same to the other side all good alright mate so now the nerves in the head and neck feels a bit weird there's a lot of funny things to ask you to do any changes of sense of smell I don't taste or smell but that's come back I wouldn't say I've no chain I wouldn't say ever apart from that but that was like obviously before christmas fine then it's got back yeah can you read what it says on that cupboard cupboard I can't read the dot word that's fine you can see that and in the corner I can see e cupboard e cupboard yeah alright you're flapping yeah yeah great and then adjust the fields of your vision just right hand and your left hand can you see my hand here yeah now keep looking at my face can you keep looking at my face can you see it in the corner of your neck perfect and here mhmm you stay in the same place here yep and here mhmm any bits missing from your vision no just pop sides for me see it here yep and here mhmm here and here yep yeah here and here there's no bits missing from that side of the foot look up to that corner of the room for me and look at my finger that's good just as the movement of the eyes as well I'm pulling my finger any pain or double vision in the extremities my well the vision does come up isn't focused it does feel a bit like with his double vision but it it's hard but when I'm focused on that everything else sort of not focused for I can't really I think everyone gets that it looks like a finger then everything else goes out of focus that's as bad as normal and then the extremes of vision any vision there at all no it does feel like a shade in my eyes though doing that does it mhmm you can get uncomfortable in the extremes okay now up and down quite quickly good so then I'll just test the sensation in your face mhmm can you touch in your ear yep same on both sides mhmm great are you able to do some face movements for me lift your eyebrows up for me that's great got you close them real tight your eyebrows in here from there that's great tap on the cheeks that's lovely give me a smile great tap on your tongue tap ah for me ah tap on your tongue side and don't let me push it back and then it's the okay so let's put kathy on your door with this thing running on alright so all the nerves in your body are fine your gp was worried about the possibility of a clot in your head did they say that to you 50% of people with the clot in the head don't have any trouble with their nerves but 50% of them do so you don't have any trouble with the nerves which is obviously good but sometimes it can present without that there's always the possibility that clot in the head can cause these your first few blood tests have come back and they don't show anything when I looked at it on my because I've got neemias there's those 3 things out of range oh yeah your platelets were ever so slightly up but they were up before your neutrophils are ever so slightly up that can happen when you're what's the 1 that's to do with your liver I didn't I haven't seen your liver test it was the 1 that but it just happened that I thought that was too horrible because and like confused with that I've never had problems with my liver yeah I didn't see that I googled where it might let it said liver mhmm then when they when it loads yep yeah it's you're right do you need the room or yes but I'll I'll wait for you so the question I guess is shall we scan your head and just make sure there's nothing worrying going on I doubt very much there is anything worrying going on I think this is sinusitis but your alt is up a little isn't it was 23 it 43 I wouldn't worry too much about it it'll probably come down again it can come up in all kinds of situations when you're on porn for 40 disease then that very much I'm glad I'm glad I it I know that happens over years and years of that being elevated but your platelets are up slightly you're responding to something your body's you know got you know there's something going on you've mounted a bit of an inflammatory response with your neutrophils I suspect this this is is all markers of acute inflammation like the sinusitis that you're describing I think that's probably what this is any history of in the family of blood clots or anything like that no haven't you so you the this it's not linked to an autoimmune disease is it why do you say that because my daughter was diagnosed from last year alright what does she do hsp mhmm yeah 5 it just affects kids doesn't it hsp but there is a form that affects adults it doesn't usually present like this usually you get the rash just like with hsp mhmm but and you plate some normal before so I think the right thing to do would be to scan your head if that's okay okay a ct where we look at the veins around your head to reassure us there's nothing concerning going on mhmm at that very least there will be anything worrying going on but it does reassure us I think it'll show sinusitis okay and if it does we can get you some treatment okay sound like a good plan yeah another question I was gonna ask you when I was feeling my symptoms like last week which I know you shouldn't really do but I was just to see if I could work out what I could like do to help it mhmm it was coming up with this thing could I pass on my phone where's my phone it's basically intracranial hypertension yeah you usually people with that will present in a much more slow way right okay the course of months and years will develop okay intermittent headaches and then progress to having constant headaches they usually eat very fat okay which does contribute to element of high pressure around their brain that affect all kinds of people but obviously women are more commonly affected than men so it's worth considering I I don't think you do have intracranial hypertension because I think it would progress slower we will if we if there is signs of intracranial hypertension we'll pick it up when we scan it okay that's good that's good also exclude well not completely excluded but I'd be quite confident with it okay that sound good yeah great I'll book the scan for you I was gonna look at the back of your eye I'd like to make that you've got a good so I will give the reading back we'll scan your head but we won't change what we do whether we scan your head or not and then if there's anything to find on the head scan we'll scan no look at the back of your eyes okay will that be done tonight then yeah is that alright yeah that's fine cool so I'll go here can you bring me bring me the port then is it on the way back I take you