Headache/ Head Injury

Question 1

Central venous sinus thrombosis

Answer 1

Think any DVT risk factors, look for a headache with neuro deficits. Call vascular and get a CT venogram

Question 2

Need LP if CT negative within 6 hours of headache onset?

Answer 2

Not usually - 100 sensitivity for SAH, within 6 hours

Question 3

When CT before LP?

Answer 3

Get the CT before the LP- structural, new seizure, altered LOC, focal deficit, papiledema, immuncompromised

Question 4

Should you delay antibiotics in a septic patient?

Answer 4

No. Always get the abx in as fast as possible, get blood cultures and then push - try within an hour

Question 5

Tx for meningitis

Answer 5

Ceftriaxone 2g IV, vancomycin 20mg/kg IV, dexamethasone 10mg IV , acyclovir

Question 6

Way think of a DDX for HA?

Answer 6

Intracranial

Extracranial

Question 7

Stroke questions

Answer 7

Neuro sx, last seen well, blood thinners, risk factors, handedness can do a NIHSS

Question 8

What do you always need to rule out before diagnosing a stroke?

Answer 8

Hypoglycaemia

Question 9

CT finding for SAH

Answer 9

The Death Star - white blood outlining the circle of Willis

Question 10

Shape of subdural on CT

Answer 10

Crescent shaped - can be quite subtle

Question 11

Epidural on CT

Answer 11

Biconvex shaped, talk and die presentation, middle meningeal artery

Question 12

Headache treatment

Answer 12

Toradol, 500 IV fluids, and maxran

Question 13

Cluster headache patho physiology

Answer 13

Dilation of the internal carotid and meningeal artery supplied by trigeminal

Question 14

Cluster headache sx

Answer 14

Unilateral retro-orbital, ipsilateral parasympathetic- lacrimation, red eye, sweating, edema

Question 15

HA in pregnancy tx?

Answer 15

First rule out pre-e/ pathology then can tx with Tylenol +/- fluids and maxeran