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Diagnostics in patients presenting to the emergency room with headache
In patients with acute headache who present to the emergency room the yield of a CTA is highest in patients with an abnormality on head NCCT. The yield in patients with normal NCCT is low. A multivariable prediction model showed that clinical symptoms have no added value over the variable ‘normal NCCT’ alone. In patients with acute headache and a normal NCCT the yield of CTA is higher than in the general population, but findings consist mainly of unruptured intracranial aneurysms that do not always have treatment implications and may generate anxiety. The sporadically found cervical dissection, CVT or RCVS may justify performing CTA. At the moment there are no clinical factors, which can predict which patients will have an abnormality on CTA after a normal NCCT.
In patients who are suspected of CVT but who have no additional risk factors besides headache, CT venography is unnecessary if the D-dimer level in serum is normal. The negative...
In patients with acute headache who present to the emergency room the yield of a CTA is highest in patients with an abnormality on head NCCT. The yield in patients with normal NCCT is low. A multivariable prediction model showed that clinical symptoms have no added value over the variable ‘normal NCCT’ alone. In patients with acute headache and a normal NCCT the yield of CTA is higher than in the general population, but findings consist mainly of unruptured intracranial aneurysms that do not always have treatment implications and may generate anxiety. The sporadically found cervical dissection, CVT or RCVS may justify performing CTA. At the moment there are no clinical factors, which can predict which patients will have an abnormality on CTA after a normal NCCT.
In patients who are suspected of CVT but who have no additional risk factors besides headache, CT venography is unnecessary if the D-dimer level in serum is normal. The negative predictive value of D-dimer in this group is very high for excluding CVT.
If CSF testing for the presence of bilirubin is required, the Leiden method, an iterative calculation model, is 100% sensitive. Specificity can be increased if the UK NEQAS method is applied on the CSF’s that test positive with the Leiden method. This workflow assures both highest specificity and highest laboratory workforce efficiency.
In patients suspected of bacterial meningitis procalcitonin determination in CSF may become a valuable marker particularly in patients with confounding factors such as recent neurosurgical intervention. The differentiation from aseptic or septic meningitis in this group is difficult and an additional marker would be valuable to avoid unnecessary antibiotic treatment.
- All authors
- Alons, I.M.E.
- Supervisor
- Algra, A.; Wermer, M.J.H.
- Co-supervisor
- Jellema, K.
- Committee
- Roos, Y.B.W.E.M.; Taphoorn, M.J.B.; Ruigrok, Y.M.; Walderveen, M.A.A.
- Qualification
- Doctor (dr.)
- Awarding Institution
- Medicine, Leiden University Medical Center (LUMC) , Leiden University
- Date
- 2018-06-28
- ISBN (print)
- 9789402810622