No nuchal rigidity in my patient, either before treatment or after.
On 2010-04-08, at 2:04 19PM, Corboy, Jacqueline B wrote:
> I haven't heard any mention of whether or not these patients had nuchal rigidity....in my experience the headache often resolves but it is difficult to mask midline neck pain with flexion, especially if the patient reports they feel the discomfort down to the midspine...I would use that to decide LP or not rather than presence of resolution of HA with medication....
> Jackie Corboy
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Bergmann Terence
> Sent: Thursday, April 08, 2010 11:07 AM
> To: [log in to unmask]
> Subject: Re: "masking" meningitis
> I don't know about meningitis, but about 20 years ago near the beginning of my career I had an adult patient come in with her 'usual migraine', but one which would not resolve with her usual triptan. She said that chlorpromazine always worked when the triptan failed. 30 minutes later she went home headache free after CPZ. Evidently overnight the headache recurred, and the next day she went to her neurologist who tapped her in the office for obvious xanthochromia. Go figure. The take home message for me is that rarely anything can present with, or act like, anything else, and there is no way to know that for sure without re-working up every presentation (which you really can't do).
> Terence Bergmann
> On 2010-04-08, at 6:48 35AM, Joe Nemeth, Mr wrote:
>> Anyone have good (any?) evidence that a dose of metoclopramide would/could resolve the headache associated with BACTERIAL meningitis?
>> Joe Nemeth MD
>> Emergency Medicine
>> Montreal General Hospital
>> Assistant Professor
>> Montreal Children's Hospital
>> McGill University Health Centre
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