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Lab Case 65

A 61 year old female presents to your Emergency Department with 8 days of fevers and rigors which are worse at night. She also complains of headaches, nausea and generalised aches and pains. Her temperature has been as high as 39 degrees celsius at home.  
emergucate.com
over 6 years ago
Www.bmj
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27

A dose of humility

Paracetamol has come in for a bit of a kicking in recent months (doi:10.1136/bmj.h1186). So we asked James Dear and colleagues to comment (doi:10.1136/bmj.h3705). They confirm that important questions about this most commonly used drug remain unanswered. The evidence of effectiveness is patchy and depends on the condition: it’s good for postoperative dental pain; okay for headache, though not as good as other analgesics; of small and probably clinically irrelevant benefit for hip and knee pain; no better than placebo for back pain; and without enough evidence of benefit for the common cold. As for its safety, nearly 60 years of widespread use are reassuring. But there are simmering concerns about subclinical liver and cardiovascular effects and questions about whether or not to intervene in cases of small therapeutic overdose.  
feeds.bmj.com
over 6 years ago
Www.bmj
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8

Focal neurological deficits after trauma

A 38 year old woman developed headache (without neck pain) and weakness of her left upper and lower limbs after a concussive head trauma with scalp lacerations in a motor vehicle crash. On examination (more than 4.5 hours after the trauma), she was conscious, alert, and in cardiac sinus rhythm. There was no carotid bruit. She scored 7 points on the National Institute of Health stroke scale (maximum possible score 42). Positive neurological findings included mild blunting of the left nasolabial fold; left hemiparesis, with extensor muscles being weaker (3/5) than flexors in the left upper limb (4+/5), flexors being weaker (4 to 4+/5) than extensors in the left lower limb (4+ to 5/5), and distal more than proximal weakness in the left arm and leg. She also had brisk deep tendon reflexes in the limbs on the left side; a left extensor plantar response; left hemianopia; and left hemisensory (including the face) hypoaesthesia for pain, cold, and touch. Eyelid ptosis or paresis of extraocular movements were not present, and pupillary size and light reaction were normal.  
feeds.bmj.com
over 6 years ago
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10

Cerebral mass in HIV infection

A 34 year old woman from the Republic of Congo with known HIV infection presented with a one day history of sudden weakness of the right arm and mild headache. She had a history of cardiomyopathy, hypertension, and epilepsy. She had not travelled abroad since she had moved to the United Kingdom 10 years ago. Other than weakness in the extensor muscles of the right arm grade 4/5 on the Medical Research Council scale, the physical examination was unremarkable.  
feeds.bmj.com
over 6 years ago
Www.bmj
0
19

A young woman presenting with severe headache

A 20 year old woman with a history of migraine with visual aura in the form of both positive (fortification spectrum) and negative features was admitted to hospital because of unilateral pulsatile right sided headache of one day’s duration. The headache was associated with photophobia, intense nausea and vomiting, right sided facial and upper arm numbness, and a right sided temporal visual field defect. She described the headache as similar to her habitual migraines in character but “the worst ever.” On examination she was normotensive and her Glasgow coma scale was 15. On neurological examination the visual field defect was confirmed and she reported reduction in light touch over the right side of her face and right upper limb.  
feeds.bmj.com
over 6 years ago
Www.bmj
0
18

A pain in the neck type of headache

A 29 year old right hand dominant chef presented to the emergency department with a four day history of feeling “not normal.” He was sent home from work because of a gradual onset of dull pain on the left side of his neck radiating up into his head, which was getting progressively worse, as well as “seeing two of everything.” The pain was not influenced by changes in posture. In addition, his right side felt numb and he was dropping things at work. He felt unsteady on his feet, which prompted him to seek medical advice. He thought all his symptoms had come on suddenly and were gradually getting worse. He denied any recent alcohol consumption, illicit drug use, seizure activity, head injury, or loss of consciousness. He had no medical history of note, apart from hypothyroidism, for which he was taking thyroxine.  
feeds.bmj.com
over 6 years ago
Sinaiem dark
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my-head-hurts

35 y F presents to ED with sudden onset worst headache of life starting 3 hours ago.  Refractory to treatment with excedrin.  No history of Migraines.  Concern for SAH. What is your management algorithm to rule out SAH?  Do you CT/LP?  
sinaiem.org
over 6 years ago
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10

Oral ibuprofen for acute treatment of episodic tension-type headache in adults | Cochrane

Frequent episodic tension-type headache (TTH) means having between one and 14 headaches per month. The condition causes much disability, and stops people concentrating and working properly. When headaches occur the pain usually goes away over time.  
cochrane.org
over 6 years ago
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2

Clinical Case 118: Thinking outside the box - Broome Docs

headaches paediatrics diagnosis thinking  
broomedocs.com
over 6 years ago
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Interventions for idiopathic intracranial hypertension | Cochrane

Review question We attempted to find all of the published randomised controlled trials (RCT, a type of rigorous study that compares one treatment option against another) that investigated any treatment for idiopathic intracranial hypertension (IIH) in any patient group. We looked at a number of outcomes including reduction in vision, improvement of headache and quality of life.  
cochrane.org
over 6 years ago
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WHO | An emergency within an emergency: caring for Ebola survivors

New research shows Ebola survivors most commonly face severe joint pains, eye problems leading to loss of vision in some cases, severe fatigue, headaches, poor concentration, and mental health challenges after recovery from Ebola.  
who.int
over 6 years ago
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12

Headaches

Learn why and how headaches develop and how to correct the underlying problems properly to live a headache free life. At http://bergmanchiropractic.com and h...  
youtube.com
over 6 years ago