Follow these five steps to help you avoid missing a posterior circulation stroke.
There was no difference in levetiracetam vs phenytoin as second-line agents after benzodiazepines for pediatric status epilepticus in median time to seizure cessation. Levetiracetam may have other advantages, as it is able to be given over 5 minutes (vs 20 minutes for phenytoin) and causes fewer adverse effects.
Thunderclap headache (TCH) is a concerning symptom and requires diagnostic evaluation. Initial head CT w/o contrast can help detect SAH with negative LR of 0.01 if performed within 6h of headache onset. However, a head CT w/o contrast can miss other causes of TCH and may require advanced imaging and LP.
The application of the Ottawa SAH rule in this relatively small sample of patients had a 100% sensitivity for identifying SAH in the ED but a lower 95% confidence interval of 78.2. The 100% negative predictive value, with a promising 95% CI of 98.6-100%, may have been driven by the lower prevalence of SAH in this study population compared to a previous validation study.