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), […]

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 […]

Bad Headaches

A thunderclap headache (TCH) has been defined as a “headache that reaches 7 (out of 10) or more in intensity within less than one minute.”

Tips for Interpreting the CSF Opening Pressure

The normal range for CSF is reported differently in various sources, with most reporting a normal range of 7-18 cmH2O in adults, though some consider the normal range 5-25 cmH2O. However, a pressure >25 cmH2O or <5 cmH2O should certainly prompt you to look for a source.  

How useful are physical examination manoeuvres for an adult patient with suspected meningitis?

The Kernig, Brudzinski and Jolt Accentuation signs have limited utility in assessing patients with acute meningitis. The poor sensitivities mean that meningitis cannot be ruled out if the signs are not present (remember sn[out]). The relatively high specificities mean that your suspicion might increase if the signs are present (remember sp[in]) but unfortunately the associated […]

How to… lumbar puncture in children

With the child in an appropriate position a line drawn between the most superior aspect of both Iliac crests (Tuffier’s line) crosses the midline over the body of L4 so the space just below this is ideal.

Pediatric Meningitis

The classic triad of fever, neck stiffness, and mental status changes is seen in less than 40% of adults and even fewer children. Meningeal findings will be present in 60% of patients

Post-Exposure Prophylaxis

Emergency care is dangerous work. Here’s a rundown of some of the greatest infection threats (HIV, Hepatitis, Meningococcaemia etc) and their appropriate prophylactic agents.  

Emergency Medicine Kenya Foundation

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