headache

None

Introduction and aims: Traditionally, neurologically pristine patients with a thunderclap headache are investigated with a non-contrast computed tomography (CT) brain scan, which if negative is followed by a lumbar puncture (LP) to exclude important secondary causes, particularly subarachnoid haemorrhage (SAH). However, misdiagnosis of such patients is still a cause of significant human and financial cost and a regular reason for medical litigation.

Although there had been occasional references to the visual aura of migraine even in ancient medicine, little attention was given to the phenomenon until the first half of the nineteenth century when French authors began to describe it. In the medicine of English-speaking countries, apart from a few descriptions, it went largely unnoticed until the British Astronomer Royal, Sir George Airy, described his own experience of the visual aura in 1865. Five years later his son, Hubert Airy, also described his experience of it and that of a number of eminent contemporary men of science.

In secondary care, some patients with acute neurological symptoms are never seen by a neurologist. Rapid access neurology clinics could provide patients with timely access to neurology services. We analysed a retrospective cohort of 12,024 consecutive patients attending the ‘immediate care’ area of the emergency department or the acute medical admissions unit of the Royal Infirmary of Edinburgh. A total of 1,036 patients (9%) presented with a neurological complaint, of whom 680 (66%) did not have any contact with neurology services.

Posterior reversible encephalopathy syndrome (PRES) is a combined clinical and radiological syndrome characterised by headaches, encephalopathy, seizures and visual loss. We present the case of a 55-year-old male who developed this condition following treatment with deoxycoformycin and alemtuzumab. We review the literature considering diagnosis, pathophysiology and optimal strategies for treatment of this condition.

Keywords Chemotherapeutic agents, encephalopathy, headache, PRES, seizures

This review is based in part on a presentation given by Dr Mackillop at the Neurology Symposium on 4 October 2012 at the Royal College of Physicians of Edinburgh.