lamontPA Posted May 8, 2012 Share Posted May 8, 2012 Hey all, I'm just curious as to everyone's use of head CT in the workup of extremely high blood pressure without headache or neuro deficits. I know that most of us would check some basic labs including chemistry panel, EKG and CXR to assess for end-organ damage, but what about head CT? A colleague of mine working in an ED treated a middle-aged female for extremely high BP (>210 systolic, >100 systolic) with only complaint of mild nausea and vomiting for 1 week. Pt was noncompliant with HTN regimen. Pt had no HA and no neuro deficit. Her labs and EKG were normal and she was treated and released. Pt returned a day later still with no HA or neuro symptoms, but had head CT that showed small hemorrhage adjacent to left lateral ventricle. Link to comment Share on other sites More sharing options...
marilynpac Posted May 8, 2012 Share Posted May 8, 2012 Look at family hx....is there CVA? Link to comment Share on other sites More sharing options...
lamontPA Posted May 8, 2012 Author Share Posted May 8, 2012 Not sure about FHx of CVA....this is all the info I got Link to comment Share on other sites More sharing options...
marilynpac Posted May 8, 2012 Share Posted May 8, 2012 What I mean is that I would be more likely to order one if there was a fx of CVA.....is this woman going through menopause? The hormonal shifts can cause extreme swings in B/P..... Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 8, 2012 Share Posted May 8, 2012 That BP with N/V...scan. Nobody will argue with you. After 6 yr in the stroke belt I have a much higher threshold for what is "high" BP, but n/v is concerning. Lab 'em up while you're at it and EKG/CXR. Don't forget the urine. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted May 8, 2012 Moderator Share Posted May 8, 2012 http://www.acep.org/clinicalpolicies/ There is a policy on asymptomatic hypertension, even at those levels. This is what I follow in my practice, and what everyone else in our system does as well. Emphasis on ASYMPTOMATIC, as the patient you were describing is not asymptomatic. I'm curious about those of you who do blood screening tests- do you do this when they will not follow-up with any primary care office, whether by choice or situation? Link to comment Share on other sites More sharing options...
CAdamsPAC Posted May 9, 2012 Share Posted May 9, 2012 That BP with N/V...scan. Nobody will argue with you. After 6 yr in the stroke belt I have a much higher threshold for what is "high" BP, but n/v is concerning.Lab 'em up while you're at it and EKG/CXR. Don't forget the urine. Yep! Elevated B/P with "end organ" sx , I'd scan their head and all of the above. Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 9, 2012 Share Posted May 9, 2012 Btw, highest BP I've seen is 289/131... Skinny AA woman with CKD who frequently tempted fate with cocaine. She swore she had not used recently though and her UDS was negative. We tried everything...labetalol IV, lasix, nypride, you name it. Ended up in ICU on a NTG drip and resolved. She did NOT have a pheo. Last I heard she is still alive and still eluding dialysis. Link to comment Share on other sites More sharing options...
YoungH89 Posted June 7, 2012 Share Posted June 7, 2012 Presumably the head CT was obtained because the n/v was thought to be a symptom of increased ICP in the setting of elevated BP. However, do you really think a small area of hemorrhage was causing this? Anybody else ever see an acute ICH/SAH without headache?? The mantra for this is thunderclap headache not thunderclap nausea. The reason why the head CT was obtained is bc as ED practitioners we need to always be sure. Especially when the patient bounces back with the same complaint. Probably a radiology overread which may have turfed the patient to ICU with a neurosurgical consult with " no neurosurgical intervention at this time" This is called treating essential htn the hard way. BTW I would have obtained the head credit as well so this is not criticism. More of a rant. Link to comment Share on other sites More sharing options...
YoungH89 Posted June 7, 2012 Share Posted June 7, 2012 Presumably the head CT was obtained because the n/v was thought to be a symptom of increased ICP in the setting of elevated BP. However, do you really think a small area of hemorrhage was causing this? Anybody else ever see an acute ICH/SAH without headache?? The mantra for this is thunderclap headache not thunderclap nausea. The reason why the head CT was obtained is bc as ED practitioners we need to always be sure. Especially when the patient bounces back with the same complaint. Probably a radiology overread which may have turfed the patient to ICU with a neurosurgical consult with " no neurosurgical intervention at this time" This is called treating essential htn the hard way. BTW I would have obtained the head credit as well so this is not criticism. More of a rant. Link to comment Share on other sites More sharing options...
YoungH89 Posted June 7, 2012 Share Posted June 7, 2012 Presumably the head CT was obtained because the n/v was thought to be a symptom of increased ICP in the setting of elevated BP. However, do you really think a small area of hemorrhage was causing this? Anybody else ever see an acute ICH/SAH without headache?? The mantra for this is thunderclap headache not thunderclap nausea. The reason why the head CT was obtained is bc as ED practitioners we need to always be sure. Especially when the patient bounces back with the same complaint. Probably a radiology overread which may have turfed the patient to ICU with a neurosurgical consult with " no neurosurgical intervention at this time" This is called treating essential htn the hard way. BTW I would have obtained the head credit as well so this is not criticism. More of a rant. Link to comment Share on other sites More sharing options...
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