Neurology

Critical Cases - Serious Headaches and Where to Find Them

Most patients presenting to the ED with a headache have a simple primary headache: tension, migraine, or cluster. Detecting the "other" etiolgies for headache, which can result in neurologic devastation or death, is often a diagnostic challenge. He we give some quick hits for one of the "can't miss" headaches, how it presents, and how to diagnose it.

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An Alternative Abortive Therapy in Refractory Trigeminal Neuralgia Pain Crisis

A 34 yo female with a history of trigeminal neuralgia presented to the Emergency Department with a chief complaint of 5 days of severe, worsening paroxysms of pain in the left trigeminal nerve distribution. The pain was refractory to carbamazepine and gabapentin. Neurology was consulted and an unconventional therapy was recommended.

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Critical Cases - Post LP Subdural Hematoma!

A 24 year old female presents to the ED complaining of a worsening headache after a lumbar puncture performed in the ED 2 days prior which diagnosed idiopathic intracranial hypertension. "No problem!" you think. Either this is just a post LP headache or possibly the patient needs more CSF drained to improve her headache. LP is a very safe procedure with minimal risk after all! Right?

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A General Approach to Febrile Seizures

4 year old boy, otherwise healthy, is rushed into the emergency room by his mom because she thinks he had a seizure. His mom states he was sitting on the ground playing a game on his iPad when he suddenly started having jerking movements of his entire body that eventually self resolved after around 2 minutes. He has never had a seizure before. He is up to date on vaccines and had an unremarkable birth history. 

 

On exam, the child is not actively seizing at this time, he just seems slightly drowsy and confused. It is noted that he is febrile to 38.2 C, otherwise vitals are stable. The rest of the exam is nonfocal 

 

What should you be thinking about? What are your next steps?  

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