Q: ICU team has been called to ED to evaluate a patient for probable subarachnoid hemorrhage (SAH) due to complain of headache. CT scan is still pending. Patient described his pain not as the worst headache of his life but says that it is progressively worse during the night, and awaken him from the sleep now more often. CT scan is most probably to find? (select one)
A) SAH
B) Tumor
Answer; B
SAH is classically described as 'worst headache of the life'. In contrast, tumor-related headaches are usually worse at night and may awaken the patient from sleep. The pathophysiology is threefold. During sleep, the partial pressure of carbon dioxide (CO2) goes up. CO2 is a very potent vasodilator. Moreover lying supine may increase the intracranial pressure (ICP). Also, there is a decreased cerebral venous return.
Other signs pointing towards brain tumor are progressive symptoms, and nausea and vomiting which is prominent in the morning.
#neurology
#oncology
Reference:
1. Schankin CJ, Ferrari U, Reinisch VM, Birnbaum T, Goldbrunner R, Straube A. Characteristics of brain tumour-associated headache. Cephalalgia. 2007 Aug;27(8):904-11. doi: 10.1111/j.1468-2982.2007.01368.x. Epub 2007 Jul 17. PMID: 17635527.
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