0071643192.pdf

DIAGNOSIS

■ CT scan is notthe imaging of choice (is often normal).

■ Obtain angiography (CT angiogram has not been fully evaluated) and/or

MRI/MRA to confirm diagnosis.

TREATMENT

■ Surgical

■ Anticoagulation

Cerebral Venous Thrombosis

CAUSES

Causes include adjacent local infection, direct injury (eg, trauma) or hyperco-

agulable state (eg, pregnancy).

SYMPTOMS/EXAM

■ Symptoms are varied and often vague.

■ Headache is the most common presenting complaint.

■ Altered mental status, focal neurologic deficits, papilledema, or seizures

may occur.

DIAGNOSIS

■ CT and standard MRI scanning are useful only if positive (cannot exclude

the diagnosis).

■ Magnetic resonance venography (MRV) combined with MRIis imaging

modality of choice and has replaced angiography.

■ CT venography is being evaluated as a possible imaging method.

TREATMENT

■ Heparin

■ Catheter-based thrombolysis if severe symptoms

Post—Lumbar Puncture Headache

CAUSES

A post-LP headache develops within 24–48 hours of LP due to persistent CSF

leak from the LP puncture site.

SYMPTOMS/DIAGNOSIS

Headache that is worse with upright posture and improved with lying flat

TREATMENT

■ Simple analgesics

■ Intravenous fluids

■ Caffeine IV

■ Blood patch, if no relief with the above measures

NEUROLOGY

Caffeine IV can be very

effective in treating

post-LP headaches.