Neuro Emergencies

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    Subarachnoid Hemorrhage

    • Definitions:
      • "Thundercalp Headache", "Worst headache of life"
      • Defined as: Severe headache that reaches maximum intensity within 60s of onset. 
      • 25% of "Thunderclap Headache" is SAH --> Neurosurgical Emergency
    • Other Dx:
      • dural sinus
      • thrombosis
      • meningitis
      • migraine
    • Diagnosis:
      • 1st test: Non-Contrast Head CT
      • 2nd test: (if CT negative) --> Lumbar Puncture
        • Evaluate for erythrocytes or xanthochromia.
        • Xanthochromia describes a yellow discoloration of the CSF from breakdown of erythrocytes, which may not develop for at least 6 hours after the initial event.
      • Normal CSF has a very good negative predictive value (generally excludes)
      • 3rd Test: (If all normal) --> rule out other causes:
        • MRI Head
        • MRI Angiography: Cervicocephalic arterial dissection, internal carotid artery dissection (often Horners)
        • MRI Venography:  Deep venous thrombosis and cerebral venous sinus thrombosis. 
    • Treatment:
      • Neurosurgical referral
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