Acute Headache: Meningitis and Temporal Arteritis

by Carlo Raj, MD

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    Let’s now take a look at acute severe headache. What caused the intracerebral hemorrhage resulting in such a secondary headache? Subarachnoid, parenchymal, meningitis, temporal arteritis, hypertensive urgency, cluster headache, and sinus thrombosis. Remember, with an acute severe headache, with a hypertensive urgency versus something known as your let’s say when we talked about hypertension, we had crisis and we had urgency. We talked about the differences between the two. Under acute headache, here once again, subarachnoid hemorrhage. We know about the thunderclap. We’ve talked about this being the worst headache in the patient’s life. Severe, nausea, and vomiting, altered level of consciousness, and may present in coma worst case scenario. We talked about the Hunt and Hess scale. And may have a focal neurologic deficit and signs of meningismus. Remember, we talked about if there was a berry aneurysm which was large enough and it ruptured, may result in a subarachnoid hemorrhage. If left untreated, may also result in a, perhaps, herniation. Intraparenchymal hemorrhage; acute in onset. Focal deficit commonly occurs simultaneously. Altered level of consciousness related to location and size of the bleed. And small bleed in pons can significantly depress consciousness. That’s important. Do not confuse this with subarachnoid hemorrhage. This is hemorrhage taking place of the brain structure itself. Larger cerebral bleed can cause edema, mass effect, and perhaps even herniation. With meningitis, we’ll talk about this in great detail. Let’s talk about the headaches that are associated. In bacterial meningitis where we have glucose being decreased, neutrophils being elevated, protein being elevated. Here, we have headache which is usually diffuse. Fever and meningismus are typical. May be absent in elderly or immunocompromised. Look for that, please. Be careful. Fever may not be necessarily seen. Alteration in level of consciousness is frequent. I want you to compare...

    About the Lecture

    The lecture Acute Headache: Meningitis and Temporal Arteritis by Carlo Raj, MD is from the course Headache. It contains the following chapters:

    • Acute Severe Headache
    • Acute Headache: Meningitis
    • Acute Headache: Temporal Arteritis

    Included Quiz Questions

    1. 14 - 15
    2. 3-4
    3. 7-8
    4. 9-10
    5. 5-6
    1. Throbbing type
    2. Worst ever headache the patient ever had.
    3. Migraine type of headache
    4. Dull constant headache
    5. Constrictive kind of headache
    1. It is classified under small vessel vasculitis.
    2. Temporal arteritis is also called as Gaint cell arteritis.
    3. ESR is usually elevated with temporal arteritis.
    4. Headache is usually unilateral to began and consequently becomes bilateral.
    5. Firm and tender cord like structure is usually palpable in temporal arteritis.
    1. Temporal artery biopsy
    2. ESR estimation
    3. Fine needle aspiration of the temporal artery
    4. CT of the skull
    5. Ultrasound of the temporal artery

    Author of lecture Acute Headache: Meningitis and Temporal Arteritis

     Carlo Raj, MD

    Carlo Raj, MD

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