mash
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A 38-year-old man presents to the emergency room with the sudden onset of a severe headache while chopping wood. This is the worst pain he has ever experienced, and it is accompanied by photophobia and vomiting. Which of the following procedures provides the best chance of making the diagnosis?
A. CT scan of the head
B. Lumbar puncture
C. CT scan of the head and lumbar puncture
D. ECG, lumbar puncture, and x-rays of the skull
E. Pneumoencephalogram
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| piter
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C. CT scan of the head and lumbar puncture ?
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| intern_doc
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Sound like Subarachnoid hemorrage
I would pick head CT w/o contrast (choice A) to look for blood in the subarachnoid space. Only to LP if CT is negative to look for RBCs
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| suvi21
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classic case of SAH. I would go for CT first.
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| peekay
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i don't think it will be appropriate to go for CT without doing LP.
LP first and than send pt for CT.u will get LP resuLt first and plus u can visually see if blood is present in all three tubes of CSF.
ANS:C
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| mani
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i think CT is enough, seems a classical SAH. whats the answer mash?
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| mash
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ans is ct scan and LP
but im not able to make out why wud they do LP when CT wud suffice to reach the diagnosis..
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| mani
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my point is the same too. CT is sufficient
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| rida
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just a guess, maybe the LP is to rule out bacterial or viral causes??
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| mani
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u r rite rida. "worst ever headache" is for meningitis as well. this sums it up
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| peekay
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GUYS YOU GOTT TO FOLLOW THE PRTOCOL FOR SUCH CASE AND THAT WOULD BE
** DO THE L.P AND THAN SEND PT FOR CT SCAN.
PLEASE UNDERSTAND THE IMPORTANCE OF L.P
IT IS A QUICK WAY OF MAKING THE DIAGONOSIS OF S.A HEMORRAGE SINCE THERE WILL BE BLOOD IN ALL THREE TUBES AND IN ADDITION TO THAT LAB RESULTS WILL HELP U AS WELL.
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| mmoghbelli
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LP is 100 percent accorate is SAH, and it is the thing to do to be sure of SAH, but I would choose CT in clinical setting...I think the q wants the lp answer. Right?
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