RT Journal Article
SR Electronic
T1 Headache in an HIV positive patient: diagnostic challenges and approach to treatment 
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 548
OP 550
DO 10.7861/clinmedicine.16-6-548
VO 16
IS 6
A1 Andrew Creamer
A1 Stefanos Ioannidis
A1 Thomas Wilhelm
A1 Tabitha Mahangu
A1 Marc Lipman
YR 2016
UL http://www.rcpjournals.org/content/16/6/548.abstract
AB 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.