Ep 161 Red Flag Headaches: General Approach and Cervical Artery Dissections

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 2 November 2021

⏱️ 71 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this Part 1 or our two part podcast series on Red Flag Headaches we discuss a general approach, tips and tricks to assessing patients who present with headache followed by a deep dive into cervical artery dissections. With the help of Dr. Roy Baskind and Dr. Amit Shah we answers questions such as: what are the big 4 headache diagnoses that are not routinely picked up on plain CT or LP? Why are the symptoms of cervical artery dissection often fluctuating? Why do the symptoms of cervical artery dissection sometimes seem to not fit an anatomical distribution? What are the key clinical features that would trigger you to suspect cervical artery dissection? How do you decide which patients require a CT angiogram? What is the evidence for a causal relationship between chiropractic manipulation and cervical artery dissections? What is evidence for antiplatelet agents, anticoagulants and thrombolysis in the management of cervical artery dissection? Which patients with cervical artery dissection can be safely discharged from the ED and many more...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast with your host, Dr. Anton Hellman,
0:06.9	bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.
0:14.7	EM cases is part of SREMI, Schwartz-Risman Emergency Medicine Institute,
0:18.7	the nonprofit organization dedicated to improving
0:21.0	EM care through research and education. The opinions expressed on this podcast are intended for
0:24.5	information and education purposes only and should not be used to diagnose treat or prevent any medical
0:26.8	condition, nor should they be used as a substitute for medical advice from qualified practice and
0:29.0	physician. We see patients with headache and the ED like all the time. Thankfully,
0:36.4	98% of patients who present to the ED with a headache have a benign cause
0:40.7	of their headache.
0:41.9	Of the remaining 2%, 1% will be diagnosable on plain CT or LP, like subarachnoid hemorrhage
0:49.9	or meningitis, for example.
0:51.9	But the other 1% can't be ruled out on plain CT and LP very easily.
0:58.7	This podcast is going to be about the life, vision, or limb-threatening diagnoses requiring
1:04.7	fairly urgent diagnosis and treatment that you really generally can't rule out on CT or LP.
1:12.5	We all know the red flags for subarachnoid hemorrhage.
1:16.1	Abrupt onset, unlike previous, maximal at onset, exertional, neck stiffness, etc.
1:22.5	And we have very good decision tools to help us decide which patients to consider the diagnosis in and how
1:28.0	to work up subarachnoid hemorrhage. And the topic's been done to death in EM, actually.
1:33.2	And we also know the presentation of bacterial meningitis, right? Fever, altered mental status,
1:38.5	headache, and stiff or rigid neck with jolt accentuation of the headache on exam. So we're not going to cover subarachnoid hemorrhage and meningitis in detail in this podcast.
1:48.2	Those were covered in episode 13, part one and episode 14 part one.
	...

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