CT before LP?
If you think CT will show a cause for the headache, do a CT If a CT is indicated for other reasons (depressed conscious level, focal neurology), do a CT If a GCS 15 patient is to undergo LP for suspected (or to rule out) meningitis, and they have a normal neurological exam (including fundi), […]
A systematic approach to the interpretation of Computed Tomography of the head
Meningitis
CNS infection should be considered in all patients with a headache, neck stiffness, fever, altered sensorium, or diffuse or focal neurological findings. pneumoniae is one of the two leading causes of bacterial meningitis in adults. Mortality from S. pneumoniae is 30%. pay close attention to cranial nerves 2, 3, 4, and 6 Altered mental status […]
Approach to Headaches
Acute Migraine Treatment
CT for Subarachnoid Hemorrhage
A negative head CT in a neurologically normal patient, with a thunderclap headache presentation, a clear time of onset, and a modern CT scanner performed within 6 hours of onset read by an attending radiologist results in a post test risk of SAH of 1 – 2/1000 patients. A shared decision strategy should be used […]
A Thunderclap Headache
A thunderclap headache is defined as a very severe headache that reaches its maximum intensity within 1 minute. One of the most common causes is subarachnoid hemorrhage, but what else can cause a it?
Subarachnoid Hemorrhage
Never ignore a headache that’s ‘different’, ‘never felt before’, ‘worst’ or not subsiding with ‘usual’ medicines…get a non-contrast CT Head
What’s the best drug for intractable migraines?
Metoclopramide (Plasil) has the highest medical evidence.
