Author: Mohomed Ashraf Vahedna / Editor: Nick Tilbury / Codes: NeuP2, NeuP7, RP4, SLO11, SLO5, SLO9, TP1 / Published: 06/12/2022

A 14-year-old is brought into the emergency department (ED) with a headache that started 4 days ago.

The headache came on gradually and he tells you it is about 4/10 in severity. The pain is mainly frontal and over the top of his head. He finds it uncomfortable to look at the light and had 1 episode of vomiting earlier today. The headache doesn’t seem to be worse at any time of day and isn’t worse with coughing or any particular posture. He has no neck stiffness, fever or rash. He has had no recent head injury.

His uncle had a subarachnoid haemorrhage (SAH) but his parents are unsure how old he was when he had it.

He has never tried any street drugs, does not take any regular medications and has been using paracetamol intermittently for this headache.

His observations are as follows:

  • HR: 90/min
  • BP: 142/83
  • RR: 20/min
  • SpO2: 99% on air

On examination he has an isolated left 6th nerve palsy and has double vision on left lateral eye movement. No one had noticed this at home. The rest of the examination of the eye is normal.

You also note he has a raised BMI.

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