53 y/o woman presenting with HEADACHE

Commencez. C'est gratuit
ou s'inscrire avec votre adresse courriel
53 y/o woman presenting with HEADACHE par Mind Map: 53 y/o woman presenting with HEADACHE

1. HOPC

1.1. Site

1.1.1. Generalised pain

1.2. Onset

1.2.1. Sudden

1.3. Character

1.3.1. Heavy/pressure

1.4. Radiation

1.4.1. Upper back

1.4.2. Neck

1.5. Associated symptoms

1.5.1. Photophobia

1.5.1.1. Meningism?

1.5.2. Fevers

1.5.3. Noise intolerance

1.5.4. Vomiting

1.6. Time

1.6.1. Continuous, started on Friday and continued to Saturday - almost 24 hrs

1.7. Exacerbating/alleviating factors

1.7.1. Paracetamol ineffective

1.7.2. Vomiting ineffective

1.8. Severity

1.8.1. 9/10 severity

2. PMH

2.1. Migraines

2.1.1. 1-2/month, resolve on vomiting

2.1.2. Does not use therapeutic treatment

2.2. Sciatica

3. Ddx

3.1. Red Flags

3.1.1. GCS

3.1.2. Sudden onset, worst headache

3.1.2.1. SAH

3.1.3. Focal signs

3.1.4. Visual acuity

3.1.5. Headache worse on lying down

3.1.6. Constitutional symptoms

3.1.7. PMHx - HIV?

3.1.8. Meningism

3.1.8.1. Fever

3.1.8.2. Stiff neck

3.1.8.3. Headache

3.2. VIVID = sinister causes

3.2.1. Vascular

3.2.1.1. SAH

3.2.1.2. Haematoma

3.2.1.3. Cerebral venous sinus thrombosis

3.2.1.4. Cerebellar infarct

3.2.2. Infection

3.2.2.1. Meningitis

3.2.2.2. Encephalitis

3.2.3. Vision-threatening

3.2.3.1. Temporal arteritis

3.2.3.2. Acute glaucoma

3.2.3.3. Cavernous sinus thrombosis

3.2.3.4. Pituitary apoplexy

3.2.3.5. Posterior leucoencephalopathy

3.2.4. ICP

3.2.4.1. SOL

3.2.4.2. Cerebral oedema

3.2.4.3. Hydrocephalus

3.2.4.4. Malignant HT

3.2.5. Dissection

3.2.5.1. Carotid dissection

3.3. Non-sinister causes

3.3.1. Migraine

3.3.2. Sinusitis

3.3.3. Medication overuse

3.3.4. TMJD

3.3.5. Trigeminal neuralgia

3.3.6. Cluster headache

3.3.7. False localising sign of infection?

3.3.7.1. Other VIRAL INFECTION

3.3.7.1.1. Flu

4. DHx

4.1. Naproxen PRN

4.2. NKDA

5. O/E

5.1. Tachydardia

5.1.1. Haemodynamic instability

5.2. Fever 39 degrees

5.2.1. Infection

5.3. Normal BP

5.4. Expiratory wheeze on auscultation

5.4.1. ?Pneumonia

5.5. No neck stiffness

5.6. Productive cough

5.6.1. ?Pneumonia

5.7. No rash

5.7.1. Commonly seen in N.meningococcus causing meningitis

5.8. No focal neurological signs

5.8.1. Unlikely to be encephalitis

6. Meningitis

6.1. Inflammation of the meninges

6.1.1. Bacterial

6.1.1.1. Strep pneumoniae

6.1.1.2. Neisseria meningitidis

6.1.1.3. Listeria monocytogenes

6.1.1.4. Haemophilus influenzae

6.1.1.5. Mycobacterium tuberculosis

6.1.2. Viral

6.1.2.1. HSV

6.1.2.2. HIV

6.1.2.3. Mumps

6.1.2.4. West Nile Virus

6.1.3. Fungal

6.1.3.1. Cryptococcus

6.2. Symptoms

6.2.1. Headache

6.2.2. Neck stiffness

6.2.3. Fever

6.2.4. Confusion

6.2.5. Photophobia

6.2.6. Vomiting

6.2.7. Seizures

6.3. Risk factors

6.3.1. <5 or >65 y/o

6.3.2. Crowding

6.3.3. Cancer

6.3.4. Exposure to pathogen

6.3.5. Immunodeficiency

6.4. Investigations

6.4.1. LP

6.4.1.1. High protein

6.4.1.2. Low glucose

6.4.1.3. Culture and Gram stain CSF, PCR

6.4.2. FBC

6.4.3. Blood cultures

6.4.4. CRP

6.4.5. U&Es

6.4.6. CT/MRI head

6.5. Treatment

6.5.1. Bacterial

6.5.1.1. IV Ceftriaxone

6.5.1.2. If TB - active TB treatment

6.5.2. Viral

6.5.2.1. Usually resolves independently

6.5.3. Fungal

6.5.3.1. IV amphotericin and flucytosine

7. Encephalitis

7.1. Inflammation of the brain parenchyma

7.1.1. Infective

7.1.2. Non-infective

7.2. Risk factors

7.2.1. <1 or >65 y/o

7.2.2. Immunodeficiency

7.2.3. Viral infections

7.2.4. Animal/insect bites

7.3. Symptoms

7.3.1. Fever

7.3.2. Rash

7.3.3. Focal neurological signs

7.3.4. Cough

7.3.4.1. Caused by viruses

7.3.5. Meningismus

7.3.5.1. Headache

7.3.5.2. Photophobia

7.3.5.3. Neck stiffness

7.4. Investigations

7.4.1. FBC

7.4.2. Peripheral blood smear

7.4.3. U&Es

7.4.4. LFTs

7.4.5. Throat swabs

7.4.6. CXR

7.4.7. Blood cultures

7.4.8. Sputum cultures

7.4.9. CT/MRI brain

7.4.9.1. LP

7.5. Treatment

7.5.1. Aciclovir

8. THx

8.1. Holiday to the Philippines 3 months ago

8.2. With family

8.3. 5 weeks

9. SH

9.1. Non-smoker

9.2. Non-drinker

9.3. No recreational drugs

10. FH

10.1. Unremarkable