Meningitis/HA Flashcards
What are symptoms of meningitis
Fever chills nausea vomiting headache nuchal rigidity
What are PE exams you can do to evaluate meningitis
Kernig
Brudzinski
What diagnostic studies would you order to work up meningitis
LP
CT
Describe what the CSF and bacterial meningitis may show
Very high opening pressure cloudy appearance elevated protein (~418) decrease glucose 80% neutrophils 70% bacteria Gram stain CSF wbc >1000 culture positive 65%
Describe what does CSF may look like with a septic meningitis
Pressure slightly high clear or cloudy elevated protein normal or low glucose mostly lymphocytes gram-negative stain CSF wbc 25 to 1000 negative bacterial culture
How do you treat bacterial meningitis in:
Child <1 mo?
Person >1 mo?
Age >50?
Ampicillin + cefotaxime or ampicillin + aminoglycoside
Vancomycin + ceftriaxone
Ampicillin + vancomycin + ceftriaxone
How do you treat a aseptic meningitis
Supportive
antipyretics
IVF
anti-emetics
What are some vaccines that can prevent bacterial meningitis
HIB
PCV 13
MCV4
PPSV23
If the Neural exam is normal do you need to CT before LP
No
When must you get a CT before LP
Immunocompromised patient history CNS disease new onset seizure papilledema abnormal level consciousness FND
What are headache red flags
Worst headache of their life sudden onset fever nuchal rigidity thunder clap focal neuro signs papilledema Triggered by cough or exertion worsening pattern personality change Older than 50 new onset with pregnancy tenderness over temporals artery
What is the snoop acronym for Headache red flags
S: Systemic sxs (fever, weight loss) S: 2ndary RF (HIV, CA) N: neuro sxs (confusion) O: onset abrupt O: older P: prev ha hx
What are important history questions you may want to ask a person with a headache
Number of headaches per month triggers trauma associated symptoms (aura diplopia nausea vomiting) medications (OCP) environmental factors Comorbidities
What PE systems should you check in the work up of a headache
Head: Trauma, temporal bruits Eye: Acuity, Perla, papilledema, EO MI Neck:Rigidity bruits CV/pulm Neuro: Mental status testing, CN exam, motor/reflex symmetry, cerebellar, sensory test Gait exam
What is the criteria for migraine without aura
5 episodes consisting of;
At least 2;
- Unilateral
- moderate to severe
- pulsatile
- aggravated by movement
At least 1
- Nausea
- photophobia and phonophobia
What is the criteria for migraine with aura
Criteria same as without aura but headache is preceded by >1 neurologic symptom
- visual: scintillating scotona, fortification spectra, photophobia
- sensory: numbness, paresthesia
- other: weakness, aphasia
What is the acute abortive treatment for migraines
NSAIDs acetaminophen triptan’s (sumatriptan) opiates anti-medics (promethazine)
What are preventative treatments for migraines
CCB
beta blocker
tricyclic antidepressants
OCP
What are non-pharmacologic treatment for migraines
Lifestyle modifications
headache diary to ID triggers
stop smoking
What is the criteria for tension headache
At least 10 episodes <1 day/mo
>30 min-7 days
At least 2 of the following
- bilateral pressing or tightening
- mild to moderate
- not aggravated by routine exertion
Both
- No nausea vomiting photophobia phonophobia
** frequent as as above but >1 but <15days/mo x3mo
What is the acute treatment For tension headaches
Aspirin 325-1000mg q4-6hrs acetaminophen (same^) ibuprofen 400-700 q6hrs naproxen 250-500 bid Excedrin
What is the chronic treatment for tension headaches
Amitriptyline
fluoxetine
Tizanidine
What are non-pharmacological treatments for tension headache
Stop smoking relaxation acupuncture PT exercise
What are the signs and symptoms of a cluster headache
Sharp pain around the eye sudden onset rhinorrhea lacrimation triggers
