Tornwaldt’s cysts are sometimes a bit of a headache A 41‐year‐old woman presented complaining of moderate to severe episodic occipital headaches and cervical pain. The headache had a constant aching quality and when severe radiated forwards to the left face and shoulder. These symptoms had commenced 3 years earlier in association with a severe upper respiratory tract infection, requiring 7 days of i.v. antibiotics at another institution. Two similar episodes occurred 6 and 18 months before her current clinical presentation each lasting about 4 weeks, both were associated with mild upper respiratory tract infection symptoms and responded to 2–4 weeks of oral Augmentin (GlaxoSmithKline, Melbourne, Australia) duo forte therapy. During these presentations, the patient reported an unremitting occipital headache and left cervical myalgia, with episodes of distressing halitosis accompanied by intermittent foul tasting purulent nasopharyngeal secretions and the constant feeling of left ear fullness. Between each episode, the patient was free of pain, upper respiratory tract symptoms and halitosis. The patient had never had nasopharangeal surgery or invasive respiratory procedures. Neurological examination was entirely normal. Magnetic resonance imaging (MRI) of head and spine showed normal brain, brainstem and spinal cord structure with some minor L4–S1 disc disease. However,
Internal Medicine Journal – Wiley
Published: Jan 1, 2007
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