0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
362 Clostridium Infections Cluster Headache■Antibiotic of choice is penicillin; metronidazole, imipenem, chlo-
ramphenicol also with good activity, but less clinical experience;
cefoxitin has variable activity against clostridia and should not be
used; clindamycin is active against C perfringens, but other species
are less susceptible
■Food poisoning is self-limited and requires no therapy.follow-up
■Patients with clostridial myonecrosis require at least twice-daily
follow-up to assess the need for additional debridement or amputa-
tion.complications and prognosis
■Loss of limb and disfigurement from surgery
■Mortality in antibiotic era about 25%
■Early diagnosis and prompt surgical intervention improve outcome.Cluster Headache....................................
CHAD CHRISTINE, MD
history & physical
■Brief, severe unilateral, nonthrobbing pain in & about eye
■Typically 10 minutes to 2 hrs in duration
■More common in men than women (5:1)
■Commonly occurs at night & may awaken pt
■May occur at the same time daily for days to weeks
■Headache-free periods may last months to years
■May be precipitated by alcohol or vasodilators
■Ipsilateral conjunctival injection & facial flushing, ipsilateral
lacrimation, nasal congestion, possibly Horner’s syndrome (ptosis,
miosis, anhidrosis)tests
■Diagnosis made clinically
■Lab tests normal
■Brain imaging normal
differential diagnosis
■Migraine headache disorder & trigeminal neuralgia excluded by his-
tory
■Temporal arteritis excluded by history & sed rate
■Carotid aneurysm excluded by history & brain imaging