Meningitis and SAH (sub-arachnoid haemorrhage) Both cause meningism (neck stiffness, photophobia and headache) SAH more sudden, headache ever’ – ‘worse Associated with PCKD aneurysms in the Circle of Willis – Meningitis look for fever and rashes; Kernigs sign – Tension headache stress, band’ – ‘tight Trigeminal neuralgia pain on TOUCHING the face – Division of the trigeminal nerve Cf. temporal arteritis/giant cell arteritis to touch... – ‘tender’ Epidemiology: rare, typically > 50, 2:1 F:M Presentation: Unilateral/bilateral FRONTAL headache with scalp tenderness Reproduced by pressing on temples, may feel thickened pulseless temporal arteries Jaw claudication (pain on chewing), amaurosis fugax Associated: polymyalgia rheumatica (painful shoulders) Ix: temporal artery biopsy, high ESR Tx: STEROIDS urgently (empirical high dose prednisolone) without awaiting results of biopsy, as untreated risk of BLINDNESS. 3000 people/yr are blinded by temporal arteritis. Sinusitis Fever obstruction/ purulent nasal discharge Loss of smell Aggrevated by bending over Subdural Haematoma Presentation: Insidious; over days/weeks, no symptoms/worsening confusion as venous pressure builds slowly. Is a slow bleed (cf. extradural). Typically fluctuating loss of consciousness, confusion, ataxia. Typical groups: as fall over Alcoholics: Elderly: brain atrophies, pulls on venous sinuses which are then more likely to tear Aetiology: Can occur after minor head trauma! So there may be no history of head trauma. Ix: URGENT CT head, see crescent shaped bleed. Management: May need neurosurgical decompression. Extradural Haemorrhage. A Neurosurgical emergency. Presentation: High impact trauma e.g. cricket ball, RTA. impact at pterion, MMA (middle meningeal artery) sheared. Typically short history; blackout on impact, then lucid interval, followed by rapidly declining neurological status (to unconscious/dead) Increasing pressure: risk of brain herniation Ix: URGENT CT head, see lens shape bleed (see below).
Meningitis and SAH (sub-arachnoid haemorrhage) Both cause meningism (neck stiffness, photophobia and headache) SAH – more sudden, ‘worse headache ever’ Associated with PCKD – aneurysms in the Circle of Willis Meningitis – look for fever and rashes; Kernigs sign Tension headache – stress, ‘tight band’ Trigeminal neuralgia – pain on TOUCHING the face Division of the trigeminal nerve Cf. temporal arteritis/giant cell arteritis – ‘tender’ to touch... Epidemiology: rare, typically > 50, 2:1 F:M Presentation: Unilateral/bilateral FRONTAL headache with scalp tenderness Reproduced by pressing on temples, may feel thickened pulseless temporal arteries Jaw claudication (pain on chewing), amaurosis fugax Associated: polymyalgia rheumatica (painful shoulders) Ix: temporal artery biopsy, high ESR Tx: STEROIDS urgently (empirical high dose prednisolone) without awaiting results of biopsy, as untreated risk of BLINDNESS. 3000 people/yr are blinded by temporal arteritis. Sinusitis Fever obstruction/ purulent nasal discharge Loss of smell Aggrevated by bending over Subdural Haematoma Presentation: Insidious; over days/weeks, no symptoms/worsening confusion as venous pressure builds slowly. Is a slow bleed (cf. extradural). Typically fluctuating loss of consciousness, confusion, ataxia. Typical groups: Alcoholics: as fall over Elderly: brain atrophies, pulls on venous sinuses which are then more likely to tear Aetiology: Can occur after minor head trauma! So there may be no history of head trauma. Ix: URGENT CT head, see crescent shaped bleed. Management: May need neurosurgical decompression. Extradural Haemorrhage. A Neurosurgical emergency. Presentation: High impact trauma e.g. cricket ball, RTA. impact at pterion, MMA (middle meningeal artery) sheared. Typically short history; blackout on impact, then lucid interval, followed by rapidly declining neurological status (to unconscious/dead) Increasing pressure: risk of brain herniation Ix: URGENT CT head, see lens shape bleed (see below).