scholarly journals Headache OSCE Part 3: A 22-year old woman presents to the emergency department after waking up with the sudden onset of a severe headache

MedEdPORTAL ◽  
2013 ◽  
Author(s):  
Diana Barratt ◽  
Daniel Segui ◽  
Fauzia Nausheen
Keyword(s):  
Emergency Department ◽  
Sudden Onset ◽  
Severe Headache ◽  
Waking Up

PP296 Patient Involvement In An Assessment Of The Management Of Sudden Onset Severe Headache Presenting To The Emergency Department

2021 ◽  
Vol 37 (S1) ◽  
pp. 33-33
Author(s):  
Ros Wade ◽  
Matthew Walton ◽  
Melissa Harden ◽  
Robert Hodgson ◽  
Alison Eastwood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Lumbar Puncture ◽  
Patient Involvement ◽  
Primary Headache ◽  
Development Stage ◽  
Sudden Onset ◽  
Severe Headache ◽  
Advisory Group ◽  
Protocol Development

IntroductionSudden onset severe headache is usually caused by a primary headache disorder but may be secondary to a more serious problem, such as subarachnoid hemorrhage (SAH). Very few patients who present to hospital with headache have suffered a SAH, but early identification is important to improve patient outcomes. A systematic review was undertaken to assess the clinical effectiveness of different care pathways for the management of headache, suspicious for SAH, in the Emergency Department. Capturing the perspective of patients was an important part of the research.MethodsThe project team included a patient collaborator with experience of presenting to the Emergency Department with sudden onset severe headache. Three additional patients were recruited to our advisory group. The patient's perspective was collected at various points through the project including at team meetings, during protocol development and when interpreting the results of the systematic review and drawing conclusions.ResultsPatients were reassured by the very high diagnostic accuracy of computed tomography (CT) for detecting SAH. Patients and clinicians emphasized the importance of shared decision making about whether to undergo additional tests to rule out SAH, after a negative CT result. When lumbar puncture was necessary, patients expressed a preference to have it on an ambulatory basis; further research on the safety and acceptability of ambulatory lumbar puncture was recommended.ConclusionsPatient input at the protocol development stage helped researchers understand the patient experience and highlighted important outcomes for assessment. Patient involvement added context to the review findings and highlighted the preferences of patients regarding the management of headache.

PP297 Management Of Sudden Onset Severe Headache Presenting To The Emergency Department: A Systematic Review

2021 ◽  
Vol 37 (S1) ◽  
pp. 33-34
Author(s):  
Ros Wade ◽  
Matthew Walton ◽  
Melissa Harden ◽  
Robert Hodgson ◽  
Alison Eastwood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Adverse Events ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Clinical Decision ◽  
Sudden Onset ◽  
Severe Headache ◽  
Sufficient Information ◽  
Headache Onset

IntroductionSudden onset severe headache is usually caused by a primary headache disorder but occasionally is secondary to a more serious problem, such as subarachnoid hemorrhage (SAH). Guidelines recommend non-contrast brain computed tomography (CT) followed by lumbar puncture (LP) to exclude SAH. However, guidelines pre-date the introduction of more sensitive modern CT scanners. A systematic review was undertaken to assess the clinical effectiveness of different care pathways for the management of headache in the Emergency Department.MethodsEighteen databases (including MEDLINE and Embase) were searched to February 2020. Studies were quality assessed using criteria relevant to the study design; most studies were assessed using the QUADAS-2 tool for diagnostic accuracy studies. Where sufficient information was reported, diagnostic accuracy data were extracted into 2 × 2 tables to calculate sensitivity, specificity, false-positive and false-negative rates. Where possible, hierarchical bivariate meta-analysis was used to synthesize results, otherwise studies were synthesized narratively.ResultsFifty-one studies were included in the review. Eight studies assessing the accuracy of the Ottawa SAH clinical decision rule were pooled; sensitivity was 99.5 percent, specificity was 23.7 percent. The high false positive rate suggests that 76.3 percent SAH-negative patients would undergo further investigation unnecessarily. Four studies assessing the accuracy of CT within six hours of headache onset were pooled; sensitivity was 98.7 percent, specificity was 100 percent. CT sensitivity beyond six hours was considerably lower (≤90%; 2 studies). Three studies assessing LP following negative CT were pooled; sensitivity was 100 percent, specificity was 95.2 percent. LP-related adverse events were reported in 5.3–9.5 percent of patients.ConclusionsThe evidence suggests that the Ottawa SAH Rule is not sufficiently accurate for ruling out SAH and does little to aid clinical decision making. Modern CT within six hours of headache onset (with images assessed by a neuroradiologist) is highly accurate, but sensitivity reduces considerably over time. The CT-LP pathway is highly sensitive for detecting SAH, although LP resulted in some false-positives and adverse events.

An Acute Severe Headache

2016 ◽  
Vol 15 (2) ◽  
pp. 104-106
Author(s):  
Adnan Azim ◽  
◽  
C Spake ◽  
T Raza ◽  
◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Sudden Onset ◽  
Severe Headache ◽  
Accurate Diagnosis ◽  
Headache Diagnosis ◽  
The Uk ◽  
Underlying Pathology

Severe headaches are a frequent presentation to the Emergency Department, accounting for around 1% of presentations. Of these, 13-16% will have a sinister underlying pathology but accurate diagnosis of headaches on the medical take remain difficult for non-specialists. A retrospective study from the UK found that, of those presenting to Emergency Department with sudden onset severe headaches, only 60% were given a specific headache diagnosis, with one third of these given their diagnoses despite an inadequate history.

scholarly journals Lipschütz Ulcer: An Unusual Diagnosis that Should Not be Neglected

2021 ◽  
Vol 43 (05) ◽  
pp. 414-416
Author(s):  
Daniela Alexandra Gonçalves Pereira ◽  
Eliana Patrícia Pereira Teixeira ◽  
Ana Cláudia Martins Lopes ◽  
Ricardo José Pina Sarmento ◽  
Ana Paula Calado Lopes
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Clinical Course ◽  
Malignant Tumors ◽  
Sudden Onset ◽  
Drug Reactions ◽  
Genital Ulceration ◽  
Sexually Transmitted ◽  
Inflammatory Processes ◽  
Genital Ulcers

AbstractThe diagnosis of genital ulcers remains a challenge in clinical practice. Lipschütz ulcer is a non-sexually transmitted rare and, probably, underdiagnosed condition, characterized by the sudden onset of vulvar edema along with painful necrotic ulcerations. Despite its unknown incidence, this seems to be an uncommon entity, with sparse cases reported in the literature. We report the case of an 11-year-old girl who presented at the emergency department with vulvar ulcers. She denied any sexual intercourse. The investigation excluded sexually transmitted infections, so, knowledge of different etiologies of non-venereal ulcers became essential. The differential diagnoses are extensive and include inflammatory processes, drug reactions, trauma, and malignant tumors. Lipschütz ulcer is a diagnosis of exclusion. With the presentation of this case report, the authors aim to describe the etiology, clinical course, and outcomes of this rare disease, to allow differential diagnosis of genital ulceration.

scholarly journals Hemoperitoneum due to Splenic Laceration Caused by Colonoscopy: A Rare and Catastrophic Complication

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Shiao-Han Chen ◽  
Jiann-Ruey Ong ◽  
Hon-Ping Ma ◽  
Po-Shen Chen
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Splenic Flexure ◽  
Splenic Injury ◽  
Underlying Disease ◽  
Sudden Onset ◽  
Health Examination ◽  
Asymptomatic Patients ◽  
Grade Ii

Numerous studies suggest that in asymptomatic patients, routine follow-up CT is not indicated due to the insignificant findings found on these patients. A 53-year-old man, who denied any underlying disease before, underwent colonoscopy for routine health examination. Sudden onset of abdominal pain around left upper quarter was mentioned at our emergency department. Grade II spleen laceration was found on CT scan. Splenic injury was found few hours later on the day of colonoscopy. It might result from the extra tension between the spleen and splenic flexure which varies from different positions of patients.

scholarly journals Use of the Emergency Department for Severe Headache. A Population-Based Study

2009 ◽  
Vol 49 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Benjamin W. Friedman ◽  
Daniel Serrano ◽  
Michael Reed ◽  
Merle Diamond ◽  
Richard B. Lipton
Keyword(s):  
Emergency Department ◽  
Population Based ◽  
Severe Headache ◽  
Population Based Study

scholarly journals Isolated fourth ventricle haemorrhage: “think beyond intracranial source’’ unusual presentation of lumbosacral spine arteriovenous malformation presentation

2019 ◽  
pp. 59-62
Author(s):  
Naresh Panwar ◽  
Manish Agrawal ◽  
Ghanshyam Agrawal ◽  
V. D. Sinha
Keyword(s):  
Arteriovenous Malformation ◽  
Fourth Ventricle ◽  
Intraventricular Hemorrhage ◽  
Spinal Column ◽  
Sudden Onset ◽  
Severe Headache ◽  
Vascular Lesions ◽  
Lumbosacral Spine ◽  
Isolated Fourth Ventricle ◽  
Spinal Arteriovenous Malformations

Spinal arteriovenous malformations (SAVMs) are rare vascular lesions and account for about 4% of primary intraspinal masses. Since SAVMs can involve any location along the spinal column and produce a host of different problems, the symptoms are extremely variable. There are few reports of simultaneous cerebral SAH and intraventricular hemorrhage (IVH) following rupture of a spinal AVM (SAVMs). Herein, we present a rare case of Lumbo Sacral spine arteriovenous malformation, which clinically manifests as sudden onset of severe headache and vomiting due to isolated fourth ventricle Hemorrhage (IVH) without cerebral subarachnoid hemorrhage.

scholarly journals Acute Retropharyngeal Calcific Tendonitis as a Rare Cause of Odynophagia and Neck Pain

2021 ◽  
Author(s):  
Prempreet Kaur Manjit Singh ◽  
Muhammad Irsyad Mohamed Noor ◽  
Rohaizam Jaafar ◽  
Amali Ahmad ◽  
Irfan Mohamad
Keyword(s):  
Neck Pain ◽  
Calcium Hydroxyapatite ◽  
Sudden Onset ◽  
Retropharyngeal Space ◽  
Calcific Tendonitis ◽  
Longus Colli Muscle ◽  
Waking Up ◽  
Point Tenderness ◽  
Superior Oblique ◽  
Hydroxyapatite Crystals

Retropharyngeal calcific tendonitis (RCT) is an aseptic inflammatory process of the superior oblique tendons of the longus colli muscle caused by the deposition of calcium hydroxyapatite crystals. We reported a 23-year-old woman who presented with a sudden onset of neck pain with odynophagia after waking up from sleep. Physical examination showed paracervical point tenderness with limited neck movement in all directions. Prior to surgery, further imaging was requested to aid in diagnosis, which in turn revealed RCT. It is important to be aware that RCT presentation may mimic other severe conditions such as retropharyngeal space abscess or meningitis.

Blue Jeans Thighs

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 417-417
Author(s):  
ROBERT R. LANTNER ◽  
SIMON P. ROS
Keyword(s):  
Emergency Department ◽  
Sudden Onset ◽  
Interesting Phenomenon ◽  
Viral Illness ◽  
History Of ◽  
Blue Jeans

To the Editor.— We wish to report an interesting phenomenon that is probably more widely prevalent than is recognized. An 18-month-old girl was brought to our Emergency Department by her parents for the sudden onset of a bluish rash on the toddler's thighs and abdomen. There was no history of recent viral illness, fever, change in appetite or activity, recent drug or toxin ingestion, or trauma. The mother thought the thighs appeared swollen, but the child was walking normally without any apparent pain or discomfort.

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