# 9 y/o female headache



## EMT John (May 29, 2012)

9 y/o female complaining of headache & general body ache / fatigued.  

Upon exam pt has bloodshot eyes, sensitivity to light, 10/10 headache, fever of 103 (rapid onset according to mom), dizziness/nausea. 
Nothing making it better or worst

B/p: 126/84
Pulse:122 sinus tach
O2: 99%

No meds, no history, no allergies, eat and drank fine today output normal and regular. 

Was at the county fair the day before. Just stayed around the house today. No exertion, no one in the family is sick or has been sick in months.


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## DesertMedic66 (May 29, 2012)

Off the top of my head I would say maybe meningitis.


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## adamjh3 (May 29, 2012)

Did she eat some funny fair food yesterday?

Any nausea/vomiting?

Are the body aches crampy feeling?

How does she respond to Kernig's and Brudzinski's tests?


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## mycrofft (May 29, 2012)

The Dreaded Flu-like Symptoms


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## al.emt (May 29, 2012)

stiff neck??? possible meningitis or flu...


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## EMT John (May 29, 2012)

Wow I'm suprised how quick people are... Yes I had the dreaded stick neck. Bacterial meningitis.


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## mycrofft (May 29, 2012)

Obviously not meningiococcal meningitis. Or you likely wouldn't be here now!
I treated a MG meningitis survivor once, lost multiple digits and plaques of skin and flesh off his legs and arms.


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## Dwindlin (May 29, 2012)

mycrofft said:


> Obviously not meningiococcal meningitis. Or you likely wouldn't be here now!
> I treated a MG meningitis survivor once, lost multiple digits and plaques of skin and flesh off his legs and arms.



I think you mean patients with meningococcal sepsis, isolated meningococcal meningitis (more common at diagnosis) carries a mortality of around 5% (pneumococcal is around 20%), vs sepsis which is around 30%, and were you will see the systemic effects you describe.


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## mycrofft (May 29, 2012)

Perhaps, probably yes. We were told the pt had m.c. meningitis, and when there have been meningeococcal outbreaks around here  which were called "meningitis" there were similar fatalities. I think you are right, or maybe the pt (pts) had both?
Very unique. Thanks!


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## Dwindlin (May 29, 2012)

mycrofft said:


> Perhaps, probably yes. We were told the pt had m.c. meningitis, and when there have been meningeococcal outbreaks around here  which were called "meningitis" there were similar fatalities. I think you are right, or maybe the pt (pts) had both?
> Very unique. Thanks!



The source of sepsis is typically the meningitis in these patients.  Just isn't as common in the states (not sure where you practice, so my data my not be relevant to you) anymore as this cluster of symptoms sets off most physicians spidey-senses and the patient gets a tap and prompt broad spectrum antibiotics.


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## EMT John (May 29, 2012)

I'm not to familiar with menigitis other then the S&S. I know bacterial meningitis is rare but we do get a few cases of it around here that I know about and this was confirmed with a LP. As for strains or what strain it was I don't know.


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## Commonsavage (May 30, 2012)

EMT John said:


> Wow I'm suprised how quick people are... Yes I had the dreaded stick neck. Bacterial meningitis.



Yep, generally any pediatric patient c/o headache is a good candidate for meningitis.  In addition to your clinical findings, and depending on etiology (bacterial vs viral), look for rash or other skin lesions.


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## TatuICU (May 30, 2012)

Damn we jump to meningitis pretty quick here huh, lol?

Nuchal rigidity present or something?


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## m0nster986 (Jun 1, 2012)

So how about a differential diagnosis?

Tumor
Encephalitis
Trauma
Sepsis


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## EMT91 (Jun 1, 2012)

Granted, I am just a basic (well I finished and passed my basic class, just waiting to take NREMT) student, but it sounds to me like the flu. Did you see if she could move her chin?


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## DesertMedic66 (Jun 1, 2012)

EMT91 said:


> Granted, I am just a basic (well I finished and passed my basic class, just waiting to take NREMT) student, but it sounds to me like the flu. Did you see if she could move her chin?



Most flus that I have seen don't have 10/10 headache and photosensitivity.


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## EMT91 (Jun 1, 2012)

firefite said:


> Most flus that I have seen don't have 10/10 headache and photosensitivity.



True. Perhaps due to my having cluster headaches, I get such symptoms as photosensitive eyes when I have the flu. I was looking at the s/s of meningitis and it could easily be mistaken for the flu. I think the main factor would be the stick neck issue.


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## EMT John (Jun 1, 2012)

Like I said before she had the stiff neck. And it was confirmed with a LP bacterial menigitis. 

I was thinking flu when I first got there but the stiff neck and all the extremes I suspected menigitis. Scary stuff being on the parent side of that.


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