Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1388 Strongyloidiasis Subarachnoid Hemorrhage (SAH)

follow-up

During Treatment

■If thiabendazole given, patient should be watched if sick, or given

early follow-up if out-patient. Hyperinfection patients need atten-

tion to fluids, diarrhea, electrolytes, and frequently need multiple

courses of treatment or even maintenance therapy.

Routine

■Assess patient for cure. Criteria are: absence of larvae on stool exam

by Baermann, Harada-Mori, or culture techniques, disappearance of

eosinophilia, and disappearance of symptoms. Retreat if necessary.

complications and prognosis

■Prognosis of light infections is good, though retreatment may be

necessary. In hyperinfection syndrome the prognosis is guarded. The

infection is controllable if treated promptly, but may need either

several courses or maintenance of periodic treatment. Reduction

of immunocompromising factors (such as steroids) if possible, and

treatment of complications such as gram negative sepsis/meningitis.

SUBARACHNOID HEMORRHAGE (SAH)

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Sudden severe headache (“worst headache in my life”)

■Nausea, vomiting, obtundation common

■Obtunded or comatose pt

■Signs of meningeal irritation

■Often no focal neurologic deficits except bilateral Babinski signs

■Middle cerebral artery aneurysm may cause aphasia, weakness of

arm & face

■Posterior communicating artery aneurysm may cause pupil-sparing

3rd nerve palsy

■Cerebral AVM usually causes deficit depending on lesion location

tests

■Lab studies: usually normal; peripheral leukocytosis or transient gly-

cosuria may occur

■Cranial CT: subarachnoid & intraventricular blood

■CSF (if CT scan normal): blood-stained