Headaches Presenting in the Emergency Department (Continued)

Cerebrospinal fluid is normal or near normal (mild elevations in protein or white blood cells). MRI and CT may be normal, may show features similar to posterior reversible encephalopathy syndrome (PRES), or may show evidence of intracranial hemorrhage, especially cortical subarachnoid hemorrhage. The diagnostic gold standard is conventional angiography demonstrating multifocal segmental vasoconstriction subsequently reversible within 12 weeks after onset. However, magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are less invasive and may provide supporting diagnostic evidence. Although there is no evidence-based study to support a specific therapy, nimodipine is the treatment most often recommended for the vasospasm.

ACUTE HYPERTENSIVE CRISIS/POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)

Patients with hypertensive crisis may present with acute or subacute posterior headaches sometimes accompanied by dyspnea, chest pain, lightheadedness, focal neurologic deficits, and epistaxis. Markedly elevated blood pressure (generally greater than 180/120 mm Hg) may be associated with hypertensive encephalopathy or malignant hypertension with retinal hemorrhages/exudates, papilledema, intracranial hemorrhage, or other organ damage, including pulmonary edema or malignant nephrosclerosis. The cause for the hypertension needs to be identified. Immediate commencement of rapidly acting antihypertensive therapies is the primary treatment; general symptom management is also needed for the dyspnea, chest pain, and so forth.

Only gold members can continue reading. Log In or Register to continue