Headache

Question 1

Thunderclap headache differential: postpartum

Answer 1

cerebral venous thrombosis

Question 2

Thunderclap headache differential: recent minor trauma

Answer 2

Vessel dissection

Question 3

Thunderclap headache differential: Horner syndrome

Answer 3

ICA dissection

Question 4

Thunderclap headache differential: Pulsatile tinnitus

Answer 4

ICA dissection

Question 5

Thunderclap headache differential: papilledema

Answer 5

Intracranial HTN or cerebral venous thrombosis

Question 6

Thunderclap headache differential: fever

Answer 6

Meningitis

Question 7

Most common cause of spontaneous SAH

Answer 7

85% are aneurysmal

Question 8

What is a perimesencephalic SAH?

Answer 8

SAH anterior to the midbrain without IVH extension

Question 9

Are perimesencephalic SAH dangerous?

Answer 9

No, these have a benign clinical course

Question 10

What clinical decision making tool can you use for SAH?

Answer 10

Ottowa SAH rule

Question 11

Why is CTA useful for SAH?

Answer 11

It won’t show a bleed but 90% of SAH are aneurysmal or will have a source identifiable on CTA. 10% will have a perimesencephalic bleed which are clinically benign so we care less about these.

Question 12

ACEP updated their policy for SAH saying that CT and CTA are now acceptable for workup of SAH, how should we approach this with patients.

Answer 12

We should do shared decision making regarding CTA vs LP since LP has historically been the standard of care.

Question 13

What is the sensitivity of non-contrasted CT of head for SAH before and after 6-hours?

Answer 13

• Within 6-hours: 97-100%

- After 6-hours: 85%