Case 19: Headache
An 11 year old boy is sent to the ER by his pediatrician to rule out meningitis. The child has had headache and fever on and off for about two weeks. Three days ago he saw his doctor and was diagnosed with the flu. However, since then the headache has worsened and the fever reached 102 Farenheit. In addition the child has developed weakness in his right leg. On exam there is questionable meningismus, but notable right leg weakness as well as 15 beats of clonus and a positive Babinski sign. The patient’s CT scan is shown below. The radiologist is uncertain of the significance of the fluid colection, but says since there is no mass effect, you may proceed with a spinal tap. What is the diagnosis? What is the best course of action?
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ANSWER: Subdural Empyema
Don’t do the LP! This is a Subdural Empyema which is a particularly bad type of brain abscess. The treatment is emergency neurosurgery. Read more just below, but first…
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BRAIN ABSCESS from “QUICK ESSENTIALS: EMERGENCY MEDICINE“
Findings: Mimics meningitis. Sx: HA > F:50, Focal neurologic:40, Sz:40
RF: Peds, immigrant, trauma, cyanotic heart dz.
Tests: CT: ĉ & ŝ contrast: regular abscess vs. Subdural Empyema(12%die). NO LP
Rx: OR (stat for empyema) > ABX: Rocephin, nafcillin, flagyl. Dilantin, (steroids)
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Pingback from JUNE MYSTERY: HEADACHE » ERPocketbooks
Time: June 1, 2007, 6:55 am
[…] An 11 year old boy is sent to the ER by his pediatrician to rule out meningitis. The child has had headache and fever on and off for about two weeks. Three days ago he saw his doctor and was diagnosed with the flu. However, since then the headache has worsened and the fever reached 102 Farenheit. In addition the child has developed weakness in his right leg. On exam there is questionable meningismus, but notable right leg weakness as well as 15 beats of clonus and a positive Babinski sign. The patient’s CT scan is shown below. The radiologist is uncertain of the significance of the fluid colection, but says since there is no mass effect, you may proceed with a spinaltap. What is the diagnosis? What is the best course of action? CLICK HERE FOR ANSWER […]
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