title: Headache in an HIV positive patient: diagnostic challenges and approach to treatment .
abstract: Headaches are a common complaint in HIV positive patients attending emergency services. A thorough understanding of the differential diagnoses, initial investigations and empirical management of this presentation is essential for the assessing physician. We discuss a case of a patient with known advanced HIV infection presenting with headache to the emergency department. Given the range of possible diagnoses, broad-spectrum antimicrobial therapy was initially commenced. This was stopped when magnetic resonance imaging confirmed a diagnosis of venous sinus thrombosis. Anticoagulation therapy was started in accordance with current clinical guidelines after discussing the rationale and options for treatment with the patient. Here, we review the guidelines and supporting evidence for management of venous sinus thrombosis, and consider the challenges and strategies for engaging a patient with previous poor attendance in their ongoing care.
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK andrewcreamer@nhs.net.
authors.forename: Andrew
authors.initials: A
authors.lastname: Creamer
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Ioannidis
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wilhelm
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Mahungu
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Lipman
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D015658:HIV Infections / Q000150:complications*; D006261:Headache / Q000209:etiology*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; HIV; headache; tumour; venous sinus thrombosis