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Thunderclap headache (SAH rule-out) — UKMLA MCQ

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HardNeurologyThunderclap headache (SAH rule-out)UKMLAMRCP Part 1MRCEM SBA

A 52-year-old presents one hour after a thunderclap headache that reached maximal intensity within seconds. Neurological examination is normal. What is the first investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Non-contrast cranial CT

The best answer is “Non-contrast cranial CT”. Urgent non-contrast CT is the first investigation for suspected subarachnoid haemorrhage. A high-quality scan within six hours that is reported by an experienced radiologist may be sufficiently sensitive in the appropriate pathway; later negative scans require further assessment. Lumbar puncture is not the first test and should not be performed immediately after onset.

Reference: NICE NG228: Subarachnoid haemorrhage: https://www.nice.org.uk/guidance/ng228/chapter/Recommendations