370 Emergency Medicine
headache persists for longer than a year. Headache may be one feature of a
larger postconcussive syndrome including nervous system instability. This
may include fragmentation of sleep, emotional lability, inability to tolerate
crowds, restlessness, inability to concentrate, and anxiety.
Posttraumatic hydrocephalus (b)is a rare complication of minor head
trauma. It presents with signs and symptoms of increased ICP, including
headache, gait instability, dizziness, nausea, and vomiting. It is often tran-
sient and may appear as a mild dilatation of the ventricles. Subdural hygro-
mas(c)can occur in the weeks following a trauma or may appear as
incidental findings. They occasionally increase in size causing symptoms
because of mass effect. Cluster headaches (d)happen daily at the same time
for days or weeks. They are unilateral, short, and boring in quality. The auto-
nomic instability of posttraumatic nervous instability overlaps considerably
with posttraumatic stress disorder (e), which has led some researchers to
postulate that they share a similar mechanism.
343.The answer is d.(Harrison, pp 2033-2034.)The patient presents
with symptoms consistent with a prolactin-secreting pituitary adenoma.
The appropriate imaging modality to diagnose a pituitary adenoma is with
high resolution MRI with thin cuts through the sella. Women often present
with amenorrhea, infertility, and galactorrhea. Men will present with decreased
libido. In both cases, extension beyond the sella may present with visual field
defects or other mass-related symptoms.
(a)Noncontrast and contrast enhanced CT are not particularly sensitive
for these lesions that sit in the sella turcica. Bromocriptine (b)or other cen-
trally acting dopamine agonists are used to treat pituitary macro- and
microadenomas. The presence of RBCs or xanthochromia in the CSF (c)is
diagnostic for a SAH. The clinical presentation is inconsistent with SAH.
(e)Removing CSF is treatment for IIH.
344.The answer is a.(Scheinfeld, 2006.) Anticonvulsant medicationsare
sometimes used as prophylaxis for migraines. Phenytoin, valproic acid,
phenobarbital, and topiramate are among the antiepileptics commonly
used to prevent migraines. Phenytoin causes fetal hydantoin syndrome,a
constellation of birth defects, including growth retardation, cleft palates,
hand deformities, and structural cardiac defects. Valproic acid has similar
effects with the addition of neural tube defects.Phenobarbital, declining
in its use for migraine prevention, causes cardiac defects, facial clefts, and