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Subarachnoid Haemorrhage – Aneurysmal — SCE Neurology MCQ

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HardCerebrovascular DiseaseSubarachnoid Haemorrhage – AneurysmalSCE Neurology

Non-contrast CT confirms basal-cisternal SAH. CT angiography shows no aneurysm, but the blood pattern remains strongly aneurysmal. What is the next vascular investigation?

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

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Correct answer: B — Catheter cerebral digital-subtraction angiography after negative CTA

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

D is correct. Once SAH is established, LP adds nothing. NICE recommends CTA first and specialist discussion; if CTA does not identify the suspected aneurysm, DSA is the reference investigation. Repeat plain CT cannot define arterial anatomy, carotid duplex misses the intracranial circulation, and MR venography investigates veins rather than a suspected ruptured aneurysm.

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