Tasty Morsels of EM #28 – Brain Abscess

March 10, 2012 by · 2 Comments
  • about 2% as common as brain tumours are but can look similar. More likely it’s a tumour not an abscess
  • 2:1 male:female
  • about 35% contiguous spread from craniofacial sites (think ears and sinuses)
    • about 90% of cerebellar abscesses are otic in orgin
  • about 25% post-trauma/surgical
  • about 25% haematogenous (think valves/lung abscess)
    • haematogenous spread usually in MCA distribution which makes sense given the anatomy and the flow
  • the rest (about 15%) have no obvious cause
  • >50% mixed flora; lots of anaerobes
  • fever in <50%
  • headache earliest symptom
  • focal signs and ataxia common (just like tumours)
  • seizures in 30%
Go forth and diagnose…

Reference:

Harwood-Nuss Clinical Practice of Emergency Medicine, 5th Ed, LWW 2010 p888

Filed Under: harwood nuss, infectious disease, tasty morsels ·

Tasty Morsels of EM #27 – Head Injury

March 8, 2012 by · 2 Comments
  • EDH is of course normally mid meningeal artery but also be:
    • diploic veins (traversing the skull)
    • venous sinuses
    • mid meningeal vein (same course as the artery)
  • the classic lucid period presentation of EDH is exception rather than the rule
  • SDHs much more likely to have delayed presentations
  • blood from an SDH can be isodense with brain about 7-14 days post event (see CT below)
  • parenchymal contusion is the most common +ve finding over all 
  • cerebral vasospasm can occur after traumatic SAH but much less common than spontaneous SAH

Delayed SDH with midline shift and all that

Refernces:

Harwood-Nuss Clinical Practice of Emergency Medicine, 5th Ed, LWW 2010

Filed Under: harwood nuss, head injury, tasty morsels ·

Tasty Morsels of EM # 26

November 3, 2011 by · Leave a Comment

I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section.

I’ll try and transfer them here for your enlightenment.

From the wonderful UMEM emergency medicine pearls.

In Bell’s Palsy

  • the presence of mastoid pain in a VII nerve palsy can be a clue to the diagnosis – I’ve seen this once. Though I only realise its usefulness in retrospect!
  • hyperacusis or sound sensitivity – due to the malfunction of stapedius (innervated by the VII; anyone know the other muscle in the ear that dampens sound?).
  • If facial paralysis is bilateral, consider Lyme disease as a possible etiology.
Filed Under: tasty morsels ·

Tasty Morsels of EM # 25

October 27, 2011 by · Leave a Comment

I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section.

I’ll try and transfer them here for your enlightenment.

From Chris Cresswell’s Emergency Medicine Tutorials

Really simple idea that I’ve never actually tried. I’ve done this on wrists multiple times but never thought of doing it for ribs.

In someone with a well defined rib fracture or two

  • perform a haematoma block
  • find the fracture site with your finger (or ultrasound if you can)
  • insert the needle in a way that you’re happy you’re in the haematoma (hitting nearby bone is a good sign)
  • inject your long-acting local of choice.
Filed Under: analgesia, tasty morsels ·

Tasty Morsels of EM # 24

October 20, 2011 by · Leave a Comment

I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section.

I’ll try and transfer them here for your enlightenment.

I confess I don’t quite know where I pulled this from but it seems pretty smart to me. I know it’s elementary eye stuff, but to be perfectly honest no one has ever taught me how to use a slit lamp, I’ve been making it up as I go and obviously didn’t pick up everything!

When using the slit lamp

  • the ant chamber exam needs the light source at 45 degrees to the angle of vision
  • “flare” means cells caught in the beam (like dust caught in the beam of a movie projection)
  • cobalt BLUE is what you need for fluroscein not green.
Filed Under: eyes, tasty morsels ·
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