Article Text
Summary
Modern medicine often leaves the history and physical by the wayside. Physicians instead skip directly to diagnostic modalities like MRI and angiography. In this case report, we discuss a patient who presented with migraine symptoms. Auscultation revealed signs of pulsatile tinnitus. Further imaging concluded that it was secondary to a type I dural arteriovenous fistula. Thanks to a proper and thorough history and physical, the patient was streamlined into an accurate and efficient work-up leading to symptomatic relief and quality of life improvement. Imaging is a powerful adjunctive technique in modern medicine, but physicians must not rely on machines to diagnose their patients. If this trend continues, it will have a tremendous negative impact on the cost and calibre of healthcare. Our hope is that this case will spread awareness in the medical community, urging physicians to use the lost art of a history and physical.
- neurology
- headache (including migraines)
- neuroimaging
- radiology
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Footnotes
Contributors JL conceived of the study, initiated the study design, performed the necessary data collection and research, and drafted the article. ZF helped with interpretation of the research and critically revised the article. This work has not been published and is not under consideration elsewhere nor does it duplicate other published work. We have had no previous submission of this manuscript to BMJ.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.