Subarachnoid Haemorrhage — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseSubarachnoid HaemorrhageSCE Neurology

A 55-year-old hypertensive man presents with sudden-onset worst headache of his life, neck stiffness and photophobia. CT head is performed within 6 hours and is normal. What is the most appropriate next step?

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Correct answer: C — Perform a lumbar puncture after 12 hours from headache onset

A normal CT head within 6 hours of onset of a thunderclap headache has a very high sensitivity for subarachnoid haemorrhage but does not completely exclude it. A lumbar puncture should be performed at least 12 hours after headache onset to allow time for xanthochromia to develop. If the LP is negative, CT angiography may be considered to exclude an aneurysm. A: Reassurance is inappropriate given the high pre-test probability. C: An immediate LP may miss xanthochromia if done too early. D: The presentation is more consistent with SAH than meningitis. E: CTA may be appropriate but LP remains the standard next step after negative CT.

Reference: RCP National Clinical Guideline for Stroke (2023); NICE CG68 Head Injury (2014)