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Doc H,


>I can recall 2 cases (I think), both in ADULTS, in which a combination of 100mg diclofenac PR (NSAID) & prochloperazine 12.5mg IM resolved a headache, which was later discovered to be associated with bacterial meningitis, although, in both cases, as far as I recall (both cases a few years back), meningitis was NOT the top differential and presentations were not "classic"...

-->just as I presumed..."I recall" evidence is...well...you know!


>I am very curious as to WHY you are asking...
-->wouldn't you know...I had a case like this...17 y.o. with previous severe H/A's in the past (no Dg) who presented with fever-H/A NOTHING else on exam x 2 days...H/A resolved with maxeran, pt looked great...
Now pathophysiologically, I would not be able to explain how a severe cytokine/proinflammatory process in the meninges would/could be "masked" by a dopamine antagonist (pain and clinical status) and seemingly alter the natural progression of a BACTERIAL meningitis! 

SAH yes...different process/disease dynamics...

If this pt. had self medicated herself prior to the ED visit and presented with fever and a 10/10 h/a which now resolved the decision to LP would not be universal.

I think the decision to/not to LP is one of the MD's comfort level...like many other things that we do, contextualization/rationalization of the case needs to be done prior to applying dogma.

jn 
________________________________________
From: Pediatric Emergency Medicine Discussion List [[log in to unmask]] On Behalf Of Doc Holiday [[log in to unmask]]
Sent: Thursday, April 08, 2010 9:29 AM
To: [log in to unmask]
Subject: Re: "masking" meningitis

From: [log in to unmask]
> Anyone have good (any?) evidence that a dose of metoclopramide would/could resolve the headache associated with BACTERIAL meningitis?


--> I have some "any" evidence...

I can recall 2 cases (I think), both in ADULTS, in which a combination of 100mg diclofenac PR (NSAID) & prochloperazine 12.5mg IM resolved a headache, which was later discovered to be associated with bacterial meningitis, although, in both cases, as far as I recall (both cases a few years back), meningitis was NOT the top differential and presentations were not "classic"...



I am very curious as to WHY you are asking...

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