A 34 yo female with a history of trigeminal neuralgia presented to the Emergency Department with a chief complaint of 5 days of severe, worsening paroxysms of pain in the left trigeminal nerve distribution. The pain was refractory to carbamazepine and gabapentin. Neurology was consulted and an unconventional therapy was recommended.
Following a severe brain injury the goal of the clinician is to prevent secondary brain injury. This entails increasing oxygen delivery to the brain by preventing hypoxia and increasing cerebral perfusion. Hyperosmolar therapy, including mannitol and hypertonic saline, is often used to decrease ICP.
Beyond mortality, the plague of bacterial meningitis on the body and central nervous system has been well described. Included in post-meningitis neurologic sequelae are sensorineural hearing loss, seizures, and focal neurologic deficits. Early administration of dexamethasone serves to reduce CNS cytokine production and limit the severe inflammation contributing to the development of these long-lasting neurologic effects. Furthermore, appropriate timing and dosing of dexamethasone therapy in these patients is crucial and can be easily overlooked.
The differentiation between peripheral vertigo and central vertigo can be exceedingly difficult as symptoms of both clinical entities largely overlap. This diagnostic dilemma can be particularly painful for Emergency Medicine physicians and their patients as the workup for central vertigo rules out "can't miss" pathology with imaging that typically takes hours to obtain.
Planning your next trip to the Rocky Mountains? Treating patients on base camp of Mount Everest? Here are the high-yield basics of High Altitude Illness including Acute Mountain Sickness, High Altitude Cerebral Edema (HACE), and High Altitude Pulmonary Edema (HAPE).
Case: 55 year old female with unknown medical history presents to the Emergency Department by EMS after having a seizure. Prior to the seizure the patient was found "acting strangely" and agitated outside on her street. Patient had a witnessed seizure after police arrived.