Author: Rajesh Thanasingh, Turan Huseyin / Editor: Steve Corry-Bass / Codes: MHP1, NeuP2, NeuP8, PhP1, SLO1, SLO3, SLO7 / Published: 14/07/2021

A 22-year-old man is brought to the Emergency Department (ED) in an ambulance. He complains of sudden onset of headache. Thirty minutes prior to headache onset he took 2 tablets of Viagra (100 mg).

He is healthy with no significant medical history and no pre-existing cardiovascular or cerebrovascular disease. He smokes 4-5 cigarettes a day and does not drink alcohol. There is no reported history of trauma. There is no history of any bleeding disorders.

On arrival to the ED, he is talking clearly but appears restless, pacing around and asking for pain relief.

Clinical examination reveals right arm weakness (power 3/5). All other systems are normal. Vital signs show a blood pressure of 142/82 mmHg, pulse rate of 65/min and a respiratory rate of 18/min. His venous gas is normal.

He receives oral analgesia and a CT brain is requested. While waiting for the CT, he becomes confused, then aggressive and drops his GCS to 7/15. He is transferred to the resuscitation room, intubated and then undergoes a CT brain.