Resumen
En este caso se describe la importancia de realizar una evaluación detallada del paciente, incluso si los síntomas parecen estar relacionados con patologías comunes.
La paciente presentaba dolor de cabeza y pérdida del olfato y el gusto, lo que inicialmente se atribuyó a una posible infección por COVID-19.
Sin embargo, la evaluación exhaustiva de los nervios craneales por parte del fisioterapeuta reveló una posible afectación del sistema nervioso central, lo que llevó a una derivación al neurólogo y a un diagnóstico final de hipertensión intracraneal idiopática.
Se destaca la importancia de la evaluación de los nervios craneales como parte integral del proceso de toma de decisiones del fisioterapeuta y la necesidad de considerar la derivación a especialistas médicos si es necesario.
El valor de la evaluación completa y el razonamiento clínico en fisioterapia
En el ámbito de la fisioterapia, es esencial realizar una evaluación completa y aplicar un adecuado razonamiento clínico. Incorporar el examen de nervios craneales en la práctica clínica puede incrementar significativamente la precisión de los diagnósticos, mejorando así la calidad de los tratamientos ofrecidos en las clínicas de fisioterapia.
Abstract original
Headache, Loss of Smell, and Visual Disturbances: Symptoms of SARS-CoV-2 Infection? A Case Report
Objective: The purpose of this case report is to describe the main components of the history and physical examination that led to idiopathic intracranial hypertension differential diagnosis, which initially was investigated as COVID-19.
Methods (case description): A 28-year-old woman complaining of constant headache and loss of smell and taste was suspected as SARS-CoV-2 infection by her general practitioner. She underwent 3 molecular swab tests, all negative, then decided to seek her physical therapist for relieving headache.
Results: The full cranial nerve examination revealed impaired olfactory (CNI), abducens (CN VI), and facial (CN VII) nerves, leading the physical therapist to refer the patient to a neurosurgeon for a suspected central nervous system involvement. The neurosurgeon prescribed a detailed MRI and an ophthalmologic examination, which allowed for the final diagnosis of idiopathic intracranial hypertension.
Conclusion: An urgent lumbo-peritoneal shunting surgery resolved the patient's symptoms and saved her sight. Despite the ongoing COVID-19 pandemic, health care professionals must pay attention to properly investigating patients' signs and symptoms using comprehensive clinical reasoning, considering the screening for referral to specialist medical attention.
Impact: A thorough physical examination is required for every patient even if patients' signs and symptoms are in line with apparent common and widespread pathologies. Cranial nerve evaluation is an essential component of the physical therapist assessment and decision-making process. The ongoing pandemic highlighted the fundamental assistance of physical therapists toward physicians in the screening and management of musculoskeletal diseases.
| Autores | Filippo Maselli Lorenzo Storari Firas Mourad Valerio Barbari Manuel Signorini Francesco Signorelli |
| revista | Phys Ther |
| DOI | 10.1093/ptj/pzad017 |