Headache Flashcards
What are the common causes of headache?
Tension migraine fever-associated sinusitis TMJ cluster trigeminal neuralgia
What should be on the emergent differential diagnosis of headaches?
subarachnoid epidural subdural intracranial bleed stroke (rare presentation) CNS infections CNS mass/increased pressure Idiopathic intracranial hypertension venous thrombosis carbon monoxide acute angle closure glaucoma temporal arteritis
What would you see on CSF eval in bacterial meningitis?
high opening pressure high WBC >80% neutrophils Low glucose high protein bacteria on gram stain.
What would you see on CSF eval in viral meningitis?
normal opening pressure less than 300 WBC 1-50% neutrophils normal glucose normal protein neg gram.
In general, what antibiotics are used for IV empiric treatment of meningitis?
in little babies: ampicillin and cefotaxime
In kiddos over 3 months and adults <50yo: dexamethasone ,cefotaxime and vancomycin.
In adults >50 yo, add ampicillin to the above regimen to cover listeria.
What are the CT findings in a subarachnoid
Blood in the ventricles, sulci and cisterns (sensitivity is highest within the first 12 hours)
What are the CT findings in an epidural
Convex or lens-shaped, clear borders, do NOT cross suture lines
What are the CT findings in a subdural
Convex, or crescent-shaped bleed with less discrete edges that can cross suture lines
Describe the timing goals for treatment of ischemic stroke.
Door to physicians: 10 minutes to stroke team 15 minutes to labwork done 45 minutes to CT ordered 25 minutes to CT interpretation 45 minutes to tPA decision 45 minutes to tPA admin 60 minutes to admission 180 minutes..
What is the time limit for tPA?.
FDA approved up to 3 hours
AHA recommended up to 4.5 hours
(best functional outcomes within 90 minutes though).
What is the ED work-up for first-time seizure
Chemistry panel and pregnancy test
Head CT in emergent setting
MRI and EEG in outpatient setting
.
How about for recurrent seizures?
.medication levels, UA, pregnancy test
Head CT IF they have had a change in seizure pattern, trauma, fever, prolonged post-ictal time, new neurologic deficit
What is the treatment for status epilepticus
ABCs (often need to be intubated to control airway)
benzos are first line
fosphenytoin/phenobarbital/valproic acid are second line
versed/pentobarbital/propofol infusions third line
What would you see on CSF in encephalitis?
elevated WBCs with a lymphocyte predominance
can also have increased RBCs in the CSF due to neuronal death
