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Even a worm can turn

A previously fit and well 24 year old US born white man presented for evaluation of abdominal pain. He had felt tired for the past two days and had been experiencing headaches, subjective fevers, and diffuse abdominal pain. Despite this he had maintained a good appetite and his normal diet, which included eating sushi at least once a week. His symptoms improved greatly after he noted a tape-like object in his stool. He had travelled to California, …  
feeds.bmj.com
about 5 years ago
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Treatment of epilepsy in people with neurocysticercosis | Cochrane

Neurocysticercosis is a common infection of the brain caused by the larvae of the pork tapeworm, migrating to the brain. Seizure is the most common symptom, while some people may present with headache, vomiting or brain swelling. This review investigates the usefulness of antiepileptic drugs (AEDs) in preventing seizures in people who did not have seizures but presented with headache or brain oedema. We also examined the usefulness of the AEDS in people with neurocysticercosis with epilepsy in terms of choice of drug, dosage, duration of treatment, cost, side effects and the quality of life.  
cochrane.org
about 5 years ago
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'Choosing Wisely' Reduces Some Unnecessary Testing

The initiative, targeting overuse of certain medical procedures, led to significant declines in headache and cardiac stress imaging, but not other low-value procedures.  
medscape.com
about 5 years ago
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A man with headache and double vision

A 78 year old man presented with a nine day history of moderately severe left retro-orbital headache. On the day of presentation he developed sudden onset complete drooping of his left eyelid and double vision.  
feeds.bmj.com
about 5 years ago
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A man with headache and double vision

A 78 year old man presented with a nine day history of moderately severe left retro-orbital headache. On the day of presentation he developed sudden onset complete drooping of his left eyelid and double vision.  
feeds.bmj.com
about 5 years ago
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A man with headache and double vision

A 78 year old man presented with a nine day history of moderately severe left retro-orbital headache. On the day of presentation he developed sudden onset complete drooping of his left eyelid and double vision.  
feeds.bmj.com
about 5 years ago
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A man with headache and double vision

A 78 year old man presented with a nine day history of moderately severe left retro-orbital headache. On the day of presentation he developed sudden onset complete drooping of his left eyelid and double vision.  
feeds.bmj.com
about 5 years ago
Sinaiem dark
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subarachnoid-hemorrhage-revisited

Does that young, well appearing patient with the “worst headache of their life” really need that lumbar puncture (LP)? It’s an issue that’s constantly weighing over physicians’ heads when evaluating a patient with headache in the emergency department. The thought of potentially missing a sentinel bleed from an aneurysm or AVM is something that keeps us up at night. Few studies have directly asked the question – is it sufficient to perform a CT angiography (CTA) of the head without a lumbar puncture in  the evaluation of subarachnoid hemorrhage?  
sinaiem.org
almost 5 years ago
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Symptoms associated with brain tumors in children

Many patients present to the Emergency Department with headaches – very few (almost none) have brain tumors despite a high level of parental concern. Let’s take a look at various symptoms and how likely they are in the diagnosis of brain tumors in children.  
pemcincinnati.com
almost 5 years ago
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Critical limb ischaemia in peripheral vascular disease: intravenous iloprost | key-points-from-the-evidence | Advice | NICE

A Cochrane review of low quality studies of prostanoids in people with critical limb ischaemia unsuitable for surgery found that compared with placebo, intravenous iloprost statistically significantly reduced major amputations, improved rest-pain relief, and improved ulcer healing. The benefit of intravenous iloprost on total amputations (major plus minor) was not statistically significant. In a randomised controlled trial (RCT) in people undergoing femorodistal bypass surgery for critical limb ischaemia, perioperative intravenous and intra-graft iloprost did not improve graft patency or clinical status, or reduce amputations at 1‑year follow-up compared with placebo. Adverse events were more common with intravenous iloprost than with placebo and included pain at the infusion site, headache, flushing, nausea and vomiting, and hypotension.  
nice.org.uk
almost 5 years ago
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Headaches in over 12s: diagnosis and management | Guidance and guidelines | NICE

This guideline covers advice on the diagnosis and management of tension-type headache, migraine (including migraine with aura and menstrual-related migraine), cluster headache and medication overuse headache in young people (aged 12 years and older) and adults. It aims to improve the recognition and management of headaches, with more targeted treatment to improve the quality of life for people with headaches, and to reduce unnecessary investigations.  
nice.org.uk
almost 5 years ago
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Emergency Medicine Literature of Note: How Many LPs Does It Take to Find SAH?

Thanks for the excellent summary. I had a few concerns about the article that made me a bit uneasy. 1) 92 true positive taps in CT negative patients, about 1 in 25. I know the literature suggests that non aneurysmal bleeding has better prognosis, however, we dont know what the other 80+ patients actually were diagnosed with. A few of the differential diagnoses for non aneurysm bleeds they list, dural sinus thrombosis, AV malformation, cerebral dissection I imagine are still worthy of diagnosis (all presumably by CT-A after the positive LP)2) 350 "uninterpretable samples" - my read of the paper, of the 350, they talk about 84 at 2 centers, in which 22 were actually investigated (5 at one site, no aneurysm, and 17 at the other with 2 - of the total of 11) were found. Oh, and 1 person walked out with meningitis. Obviously the question is regarding those 327 patients who werent investigated. They say in the discussion they would have expected 17 "incidental" aneurysms from that group - depending on how many missed aneurysms in this group, the numbers start to look less appealing, from 1 in 200 to (adding 17) 1 in 80. Would be interested in your thoughts. Agree that with 6 hour CT, LP likely headed out, however, am worried for technology creep (lets just CT all headaches before 6 hours), and also forgetting all the other diagnostic benefits of LP. ThanksBill  
emlitofnote.com
almost 5 years ago
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Comorbidities Common in Children With Headache

Epilepsy, depression, and anxiety disorders are among the most common conditions overlapping headache, particularly migraine, in kids, a new study shows.  
medscape.com
almost 5 years ago
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Practical Guidance for Headache and Migraine Management in Primary Care CME

: Are you familiar with the diagnostic criteria and newest treatments for migraines?  
medscape.org
almost 5 years ago
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SGEM#134: Listen, to what the British Doctors Say about LPs post CT for SAH

Case Scenario: A 34-year-old woman presents with acute onset of headache peaking in 30 minutes with no recent trauma, focal deficits and a normal neurologic examination.  
thesgem.com
almost 5 years ago
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Opioid and Barbiturate Prescriptions in Headache Patients

Are opioids and barbiturates continuing to be overprescribed for the treatment of chronic headache disorders and migraine? This survey looked at who is prescribing them, and why.  
medscape.com
almost 5 years ago
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Loss of Consciousness at SAH Onset Important Risk Marker

Frontline workers should ask patients presenting with severe headache and possible subarachnoid hemorrhage if they lost consciousness, researchers say.  
medscape.com
almost 5 years ago
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Use of nitroglycerin to deliver a retained placenta | Cochrane

Failure to deliver the placenta after a vaginal birth is an uncommon event that can be associated with significant bleeding and even death if left untreated. The retained placenta may be detached from the uterine wall but is trapped so that it is not expelled through the cervix or non-detached as the placenta fails to separate because of placental inhibition of uterine contractions. Conventional management involves spinal or general anaesthesia to enable introducing a hand inside the uterus to manually remove the placenta, which carries risks of infection and from the anaesthetic, and also requires special facilities. The use of uterine relaxing drugs (tocolytics), either alone or with other drugs to stimulate contractions of the uterus (uterotonics), may bring on the delivery of the placenta and avoid the need for this invasive procedure. This review included three trials that randomly assigned 175 women with the placenta remaining undelivered more than 15 minutes after delivery to either a placebo or the tocolytic nitroglycerin. Both groups received oxytocin to stimulate contractions of the uterus. Combined administration of nitroglycerin and oxytocin did not reduce the need for manual removal of placenta, blood loss, nor the incidence of severe postpartum haemorrhage. Nitroglycerin administration did not cause headache but resulted in a mild drop in blood pressure and a related increase in heart rate. Two out of the three trials had low risk of bias but this result needs confirmation in larger trials with adequate sample sizes to verify the role of nitroglycerin and other tocolytic drugs in managing different subtypes of retained placenta. The trials in this review did not specify the type of retained placenta. We have included an explanation of some of the scientific terms that are used in this review in a glossary (see Appendix 1).  
cochrane.org
almost 5 years ago
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Migraine doctor loses appeal against findings of dishonesty

A High Court judge has upheld two findings of dishonesty by the Medical Practitioners Tribunal Service against a leading headache specialist in the conduct of a clinical trial.  
feeds.bmj.com
almost 5 years ago
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Migraine doctor loses appeal against findings of dishonesty

A High Court judge has upheld two findings of dishonesty by the Medical Practitioners Tribunal Service against a leading headache specialist in the conduct of a clinical trial.  
feeds.bmj.com
almost 5 years ago