神经病学（人卫九版）8-2蛛网膜下腔出血.ppt

* * * * * * * * * * * * 12.1 Headache attributed to somatisation disorder 12.2 Headache attributed to psychotic disorder Part 3:Cranial neuralgias, central and primary facial pain and other headaches 3. Cranial neuralgias and central causes of facial pain 13.1 Trigeminal neuralgia 13.1.1 Classical trigeminal neuralgia 13.1.2 Symptomatic trigeminal neuralgia 13.18.4 Persistent idiopathicfacial pain Previously used term: Atypical facial pain ACUTE HEADACHE IN THEEMERGENCY DEPARTMENT * * * Answer to TQ #3 * Although the most common presentations of SAH are described above, there is no pathognomonic sign or symptom that can help to exclude or to establish the diagnosis. Headache may not even be part of the presentation at all. A recent retrospective study of over 200 patients who underwent aneurysmal clipping reported that 8% did not have any headache at onset of SAH, but instead presented with sudden onset of general malaise or isolated neck or back complaints.72 The study has obvious limitations due to possible recall bias from retrospective data collection by mail questionnaire. The important point is that emergency clinicians must have a high index of suspicion for this condition even with atypical presentations, as SAH is not diagnosed in one-fourth of patients with this condition on initial presentation * * * * * * * * * * * * * * * * * * * Examination and investigation Examination Neurological examination Manual palpation of pericranial muscles ( frontal, temporal, masseter, pterygoid, sternomastoid, splenius and trapezius. Fundoscopy for papilloedema Investigations If neuro examination normal none needed Investigation Neuroimaging should be arranged if Atypical pattern of headache History of seizures Neurological signs or symptoms Symptomatic illness – acquired immunodeficiency syndrome, tumours or neurofibromatosis Treatment Infrequent headache Good results from non prescription medication May need reassurance If require drugs on more than 2-3 days/wee