CT/LP

[Bjs04f]

We had begun having this discussion awhile ago in a different talk. Back then I had made mention to an article about not needing LP and how sensitive CT was getting. A follow up study
Original study
www.ncbi.nlm.nih.gov/pubmed/21768192
Follow up
www.ncbi.nlm.nih.gov/pubmed/?term=CT+within+6+hours+of+headache+onset+to+rule+out+subarachnoid+hemorrhage+in+nonacademic+hospitals.
I think this can make a large difference in these worst headaches of my life just starting patients. The next question would be since it had been established that CT is also incredibly sensitive after 8hr can we move away from LP on everyone

[kemple]

I agree, only question is did either study mention what quality of scanner or average years reading radiologists were? As everything in medicine could be open to operator dependence.

[Bjs04f]

No; mentioned 2 neuroradiologists in first and staff radiologist in second study. The important thing though is we act on rads read frequently. DC people to find out they have multi rib fx or sah missed on first

[pbruss]

i am moving away from LPs in this situation. sometimes if i am worried and or the patient does not want an LP io will do a CTA. if no aneurysm then unlikley its a sah

[Bjs04f]

www.emlitofnote.com/2016/01/is-6-hour-ct-for-sah-debate-over.html

[jpollock]

had a case last week where a 50M came in with "pop" on the left side of head while taking a BM. This sudden onset headache was the only significant headache he ever had and he was crying and saying it was the worse pain he ever felt. To make things more interesting, he had R facial droop, sensory loss and weakness to R arm and leg. I did a CT and CTA right off the bat, but even when these were negative I still couldn't bring myself to give tPA