Dr. Holly Ryan
Editor: Omar Lopez MS3
1. Headache is a very common complaint in the ED, up to 2% of patients that walk into the emergency department have the CC of HA.
A bleed in the subarachnoid space which is usually filled with CSF, to protect and cushion our brain.
This space is the closest to the actual brain and that is important physiologically because blood that sits on the brain parenchyma can cause irritation, which is why these patients are at increased risk for seizures.
Buzzwords: thunderclap headache, worst HA of my life
ACEP Clinical Guidelines and Policies
1. Risk stratification for emergent imaging in ED patients with headache?
Results: 91% of cases had a completely negative LP with absolutely no xanthochromia present. Only 4% were positive and 5% were equivocal. Completed CT angiography in the positive or equivicol patient population and found that only 4% had a cerebral aneurysm. Which led to conclude that in suspected SAH cases where CT scan in negative, the rate of detection for cerebral aneurysm with LP is 0.4%.
Management and Disposition
Controversies in Care: Seizure PPX