1. Cavernous sinus thrombosis 
-frontal/sinus pain
-waxing and waning
2. Migraines
POUNDing:
- Pulsatile
- Onset/duration 4-72 hours without treatment
- Unilateral
- Nausea
- Disabling - can't work through it
- classically: car sickness as a child
- neurological symptoms are from cerebral cortex and brainstem.
3. Treatment for migraines
- Abortive: NSAIDs (+/- antiemetics), Triptans (selctive sertotonin agonists)
- Corticosteroids are helpful to break a cluster of migraines (i.e. normally they come infrequently but they are getting them every day for a while and using abortive agents every day)
- Prophylactic: B-blockers, CCB, Topamax/neurontin/ARBs
4. GCA or temporal arteritis 
- older white female
- 15% of those with PMR have GCA
- 60% of those with GCA have PMR
- Jaw claudication - sens 34%, spec 92%
- Diplopia - sens 9%, spec 97% (unknown why this happens-- direct inflammation of CN III/IV/VI, vs ischemia to nerve or muscles)
- Headache & jaw claudication LR +8
- Scalp tenderness & jaw claudication LR +17
- Beading, enlargemnt, prominence of TA LR >4
- Temporal aretery tenderness, loss of pulse LR >2
- Abnormal ESR has sensitivity of 96%
- NSAIDs will alleviate sx, but will not treat underlying dx so don't send someone home on NSAIDs if your suspicion is high.
- Treatment is high-dose steroids
5. SDH
- Classic: AMS, somnolence, not commonly associated with headache
- Associated symptoms (% frequency)
- Falls 74%
- Progressive neuro deficit 70%
- Head trauma 37%
- Transient neuro deficit 21% (hence scan someone you think has a TIA before anticoagulation to r/o SDH)
- Seizure
6. Pseudotumor: headache in young women with visual changes.
7. Upper extremity injury: 
- 95% shoulder dislocations are anterior, 5% posterior, usually seizure or electrical shock
- Radial head fracture most common elbow fracture in adults
- FOOSH fractures:
4-10 y/o torus fracture (buckle fracture in radius)
11-16 : saltar harris II - through growth plate and metaphysis
17-40 scaphoid (risk for avascular necrosis in proximal pole
>40: colles (esp women distal radius fracture
8. IR procedures: 
- procedures with low risk of bleed, and if it bleeds, it is easily detected and controllable
dialysis access, ivc filter, centreal line removal, drainage catheter
- procedures with significant risk of bleed; bleeds are difficult to detect and to control (i.e. need way stricter coagulation parameters)
TIPS, renal bx, nephrostomy tube placement, RFA
9. General guidelines for coagulation parameters before starting IR: 
- Platelets > 50 PTT, INR <1.5
- heparin held for 3 hours
- aspirin held 5 days
- try to hold plavix
10. Contrast nephropathy 
>25% increase in Cr or abs cr increase of 0.5 mg/dL
Risk fx: pre-existing renal insufficiency (cr <60)
Diabetes
Hypovolemia
Typical CT 60-120 cc contrast
intensive procedures w lots of angios/cath can be as high as 200-300 cc contrast