Episode 14 Part 2: Thunderclap Headache – Cerebral Venous Thrombosis and Cervical Artery Dissection

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 9 May 2011

⏱️ 53 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

emergency headacheIn Part 2 of this episode on Thunderclap Headache - Cerebral Venous Thrombosis & Cervical Artery Dissction, Dr. Stella Yiu and Dr. Anil Chopra review the presentation, work-up and management of some of the less common but very serious causes of headache including Cervical Artery Dissection (CAD), Cerebral Venous Thrombosis (CVT) and Idopathic Intracranial Hypertension (IIH). They tell us the most effective ways in which we can minimize the chance of the common Post-LP Headache. They answer questions such as: How does a carotid artery dissection present compared to a vertebral artery dissection? What is the evidence for chiropractic neck manipulation as a cause for Cervical Artery Dissection? How do antiplatelets compare to heparin for the treatment of Cervical Artery Dissection? What is Spontaneous Intracranial Hypotension? What is the differential diagnosis for headache in the peri-partum patient? Does D-dimer have a role in ruling out Cerebral Venous Thrombosis in the low risk patient? What is the imaging modality of choice for suspected Cerebral Venous Thrombosis? What is the value of opening pressure when performing an LP? What are the key headache diagnoses that can be missed on plain CT of the head and would warrant further investigation? and many more.....

Transcript

Click on a timestamp to play from that location

0:00.0	Okay, so we've talked about migraine. We've talked about the best treatment for migraine.
0:03.8	We've talked about subarachnoid hemorrhage, all the controversies of working up subarachmoid hemorrhage and how to treat a subarachnoid hemorrhage. Let's go on to our third case. Case number three is a 50-year-old male who was brought in by ambulance at 9 p.m. with the chief complaint of being unable to walk.
0:21.3	His wife was present during the interview.
0:24.1	He was well until by ambulance at 9 p.m. with the chief complaint of being unable to walk. His wife was present during
0:22.6	the interview. He was well until a few days ago when he developed nasal congestion, sore throat,
0:28.7	and cough typical of his usual occasional upper respiratory tract infections. He didn't have a fever.
0:35.9	Then at about 10 a.m. that morning, after a fit of violent coughing, he experienced a gradual
0:41.0	onset over a few hours of severe, right-sided, posterior neck pain shooting into his
0:47.1	occiput.
0:48.4	He had never experienced the pain like that in the past.
0:51.2	There was no nausea vomiting and no syncope at the time. Then at 8 p.m. he was walking
0:56.9	to his kitchen and suddenly became ataxic and fell into the wall. There was no head injury. He felt
1:03.6	very dizzy and tried to call out to his wife, but could not say her name properly. His past medical
1:09.4	history was unremarkable, except that he was a 10-pack-year
1:12.9	smoker and took no medications. On exam, his vital signs were stable, except for a blood pressure of
1:19.7	160 on 95. Pulse was 80 and regular. His neurological exam revealed a GCS of 14 owing to his speech
1:27.3	deficit.
1:29.2	Pupils were equal and reactive, extraocular movements were normal, and there was no
1:33.3	nistagmus.
1:34.5	Fundai were normal.
1:35.9	His neck was supple, with no c-spine tenderness.
1:39.2	He had an abnormal Romberg and finger-in-to-nose test.
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from Dr. Anton Helman, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of Dr. Anton Helman and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.