RESUMEN
Neurological emergencies represent 15-25% of the medical take, second only to cardiac and respiratory cases. However, the UK's number of neurologists is lower than that of other developed nations. This quality improvement project aimed to develop a guideline to optimise acute headache management by non-specialists, informed by the findings of a survey and audit of doctors' knowledge and practice. In total, 62 doctors responded to our survey. 53/56 (94.6%) agreed a guideline would be useful. Knowledge of some important causes of headache was high, but was lower for others, including cerebral venous sinus thrombosis and cervical artery dissection. A consultant neurologist deemed 14/27 (51.9%) of acute headache presentations audited pre-guidelines to have had appropriate management. After guideline launch, a re-audit demonstrated this proportion was 18/22 (81.8%) (p=0.04). We conclude the investigation and management of acute headache requires optimisation and a guideline may help to achieve this.
Asunto(s)
Servicios Médicos de Urgencia , Cefalea , Médicos/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Enfermedad Aguda , Cefalea/diagnóstico , Cefalea/etiología , Cefalea/terapia , Humanos , Enfermedades del Sistema Nervioso/diagnóstico , Punción Espinal , Encuestas y Cuestionarios , Reino UnidoRESUMEN
Cellulitis is a common condition and several mimics exist which should be considered in patients who fail to respond to antibiotics. We describe the case of a patient with anaplastic large cell lymphoma masquerading as a lower leg cellulitis. The patient had failed to respond to intravenous antibiotics and a skin biopsy confirmed her diagnosis. She received radical radiotherapy to the lower leg but later developed shortness of breath and was identified to have pulmonary infiltration of the lymphoma. She died shortly afterwards from lobar pneumonia. This case highlights the importance of regularly reassessing patients with suspected cellulitis and considering alternative diagnoses in cases that fail to respond to treatment.
Asunto(s)
Celulitis (Flemón)/diagnóstico , Linfoma Anaplásico de Células Grandes/diagnóstico , Neoplasias Cutáneas/diagnóstico , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Celulitis (Flemón)/tratamiento farmacológico , Diagnóstico Diferencial , Resultado Fatal , Humanos , Pierna/patología , Neoplasias Pulmonares/diagnóstico , Masculino , Neoplasias Cutáneas/patologíaRESUMEN
We describe the case of a young female presenting with myalgia, mildly raised creatine kinase and a rash. The discussion emphasises the importance of a systematic approach to muscle symptoms, the value of a detailed hand examination and the importance of magnetic resonance imaging in the investigation of muscular symptoms.
