Parietal headache

[beabc71]

This is a 32 yo female patient, with a hystory of idiopathictrombocytopenic purpura 5 years ago. Two months ago she fell of her bike and hit her head on the left parietal area. She went to the ER where they performed a CT scan and was told  everything was okay. Five days later she woke up in the middle of the night with excrutiating pain in the right parietal area. Again she goes to the ER where they gave her morphine ( she is allergic to nsaid), triptane and benadryl, and told her is sinusitis. Te pain continues to this day, currently the vision of right eye has now dimished. Doctors keeps saying its stress. The pain is fixed on right parietal region, occasionally radiated to jaw. Optic nerve OCT is ok, visual fields with central visual field constriction, diplopia on downward gaze. C reactive  protein normal, globular sedimentation rate normal. Neurophtalmologist told is cephalea stress related. Are they missing something?

[Red_Star]

Double vision looking down is a sign of 4th (trochlear) cranial nerve palsy. Moderate frontal head trauma is a frequent cause of bilateral trochlear nerve palsy.
Surgery should be postponed for at least six months to a year as the double vision may resolve. You can use a stick-on prism called Fresnel lens which can be changed as the amount of head tilt and/or diplopia decreases.