neuro

HEADACHE – Low Risk, Pregnancy

MDM

This patient presents with a headache most consistent with ***. Differential diagnosis includes migraine versus tension type headache. No headache red flags. Neurologic exam without evidence of meningismus, focal neurologic findings. Presentation not consistent with acute intracranial bleed to include SAH (lack of risk factors, headache history). Presentation not consistent with acute CNS infection to include meningitis or brain abscess, Temporal arteritis unlikely, as is acute angle closure glaucoma given history and physical findings. Presentation not consistent with other acute, emergent causes of headache at this time. Plan to treat symptomatically with pain medication. No indication for imaging/LP at this time.***

Plan: pain medication, CT brain***, serial reassessment

HEADACHE IN PREGNANCY

This pregnant patient presents with headache of rapid onset. Etiology is unclear but includes possible preeclampsia, HELLP, SAH or other ICH. Considered, but think unlikely, CVT, Waterman’s syndrome, carotid dissection. Plan to work up with basic labs, UA to screen for proteinuria, consider head CT, pain control, reassess.

Vertigo – Low Risk

MDM

This patient presents with dizziness, most consistent with a peripheral cause, likely vertigo. Differential diagnoses includes: BPPV versus labrynthitis.*** No red flag features for central vertigo to include gradual onset, vertical/bidirectional or nonfatigable nystagmus, focal neurologic findings on exam (including inability to ambulate). Presentation not consistent with an acute CNS infection, vertebral basilar artery insufficiency, cerebellar hemorrhage or infarction, intracranial mass or bleed, temporal lobe epilepsy, multiple sclerosis, trauma, complex migraine headache. Other acute, emergent causes of vertigo are unlikely given at this time. No indication for head imaging at this time.

Plan: meclizine, supportive care, serial reassessment

Altered Mental Status – General

MDM

This is a @AGE@ @GENDER@ presenting with altered mental status, concerning for ***. The differential includes toxic metabolic etiologies such as electrolyte disturbances (Na/Ca), hypoglycemia, and uremia; acidosis states, infection (i.e. Sepsis); toxidromes of intoxication or withdrawal, hypoxemia or hypercarbia, liver disease or failure causing hepatic encephalopathy, endocrine emergencies (hyper/hypothyroidism, adrenal insufficiency), seizure, trauma, intracranial bleeds or ischemic stroke. Given this wide differential, will send basic labs and lytes to evaluate for metabolic causes, FSBS, LFTs,, TSH, ***CT head, ***blood gas. ***LP?/abx?