Non-traumatic Subarachnoid Haemorrhage

With regard to patients presenting to the ED with acute “thunderclap” headache, which of the following is correct?

A 28-year-old man presents to the ED with sudden onset of severe occipital headache, “like being hit with a hammer”. He has no past history of headaches. Which of the following features on examination help to differentiate SAH from a severe migraine?

A 36-year-old man presents with severe headache while he was bench pressing at the gym. He describes the onset as abrupt reaching maximum intensity within a few seconds. He is neurologically normal and the pain relief given at triage 1 hour ago has completely resolved his headache. Which of the following would be the best course of action?

A 48-year-old lady with a previous history of migraine presents with a severe frontal headache with associated nausea and neck stiffness. Which of the following statements regarding a headache history is correct?

It is 02:00 hrs when you see a 44-year-old man who has presented with an acute thunderclap headache (onset 2030 hrs). He is neurologically pristine and his observations are normal. You think that the patient needs investigation but the radiologist is at home.

What do you do?

At 08:30 hrs the following morning (12 hours after headache onset) the patient (Q5) arrives back from the brand new multislice CT scanner with the following report:

No evidence of SAH. No other abnormality detected.
No radiological contraindication to lumbar puncture identified.
This result does not exclude the possibility of SAH

Dr Isla Dark
Radiology SpR

Which of the following is correct regarding interpretation of the result of the CT head scan?

You have a senior Radiology report that the CT scan is normal on the patient in Q5 & Q6. The gentleman feels his headache is much better and wants to go home. After discussion of the risks and benefits with the patient you elect to perform an LP for CSF analysis in this patient.

Which of the following regarding the procedure of the LP is correct?

You have just started your evening shift when you take over the care of a patient who had presented with a headache. A CT head scan demonstrates a large anterior aneurysmal SAH.

Which of the following are important in her immediate management?

On transfer to the neurosciences centre angiography reveals an anterior communicating artery aneurysm that is amenable to endovascular coiling or surgical clipping.

Which of the following is correct regarding the patient’s management?