headaches with high temprature Flashcards
differentials if headache with high temperature
vascular - subarachnoid hemorrhages
cereberal sinus venous thrombosis
infection - meningitis ,encephalitis
space occupying lesions such as tumors and abcess
carotid dissection
IIH
migraines and tension headaches
investigations to order
fbc .ue . lft , crp , coag
blood culture
cxr
urin culture and csu
VBG
CT head if decrease in GCS and becoming more drosy
lastly LUMBAR PUNCTURE
signs and symptoms of meningitis ?
headache , neck stiffness and fever = triad
kernig sign , bruzdenski sign
seziures can also happen
confusion
nasuea and vomiting
FOCSL NEUROLOGICAL SIGNS
bacteria commonly causing meningitis ?
strep pneumonia - may follow an eoisdoe of otitis media
nesseria meningitis
listeria - immunocompromised
abx for meningitis
if i spot rashes then i would start them on benzylpenicillin
if no rashes ceftriaxone and cefotaxime
is CT head needed before an LP ?
LP can be performed in patients suspected for meningitis without a CT head ,
however this for simple cases of meningitis i.e. not obviously septicaemic, no focal neurological signs and NO decrease in consciousness
there are certain contraindications to LP
such as continuous seizure, severe sepsis and rapidly evolving rash , cardio respiratory compromise
increase risk of bleeding
and raised intracranial pressure and low GCS
how does viral menigitis differ to bacteriain csf
viral can be clear or cloudy
glucose in CS is 60=-80 percent of that in serum
protein can be high or normal
predominantly lymphocytes
who to notify if bacterial meningitis present
public health service if any form of meningitis present - so they can do contact tracing and start prophylaxis treatment of the contacts (cipro/rifaximin)
local microbiolgy team should also be informed
differential list for a patient with a purpuric rash and a fever?
gonoccocemia
bacterial septicemia with DIC
henoch scholen purpura
viral haemorrhagic fevers
