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Intractable Headaches in a Patient with Alport Syndrome with No Evidence of Brain Lesions-A Case Report

Mitchell Stotland

Alport Syndrome results in a genetic mutation in type IV collagen; one place of major significance is the glomerular basement membrane of nephrons. These patients are at high risk for glomerulonephritis and renal failure in addition to inner ear and eye pathology. This patient is a 25 year old Caucasian female with non-deaf Alport Syndrome who was hospitalized for intractable headaches with pain scale measuring 8-10 out of 10 of severity. This patient received a CT of the head, MRI, MRA and MRV of the brain that demonstrated no evidence of chronic or acute hemorrhage, acute intracranial process, chronic or acute infarction, vasculitis, brain lesions or emboli. This patient’s headaches were refractory to oral Fioricet, Aspirin, Tylenol and NSAIDS. The patient initially refused oral and intravenous analgesics including morphine, oxycodone due to the side effects of nausea, lethargy and drowsiness. The patient’s pain was moderately relieved by small doses of oral oxycodone and intravenous morphine. The patient experienced mild nausea and drowsiness from these medications; however her pain reduced over 60% in severity to a final rating of 3-4 out of 10 from an initial 8-10 out of 10 in severity. This patient was the first patient reported with Alport Syndrome and intractable headaches without evidence of acute or chronic brain lesions on brain MRV, MRI, MRA and CT imaging whose headache pain was reduced by over 60% in severity by oral and intravenous analgesics in the inpatient setting.