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Subarachnoid Haemorrhage — RACP Adult Medicine MCQ

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EasyNeurologySubarachnoid HaemorrhageRACP Adult Medicine

A 28-year-old woman presents with sudden-onset severe headache, neck stiffness, and photophobia. CT brain is normal. CSF analysis shows xanthochromia with elevated red blood cells that do not diminish across sequential tubes. What is the most likely diagnosis?

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Correct answer: A — Subarachnoid haemorrhage

Sudden thunderclap headache with meningism, normal CT, and CSF xanthochromia (indicating haemoglobin breakdown products) is diagnostic of subarachnoid haemorrhage. Non-diminishing RBCs across tubes distinguishes SAH from traumatic tap. CT angiography or conventional angiography is required to identify the aneurysm.

Reference: Stroke Foundation Australia – 2024 – SAH Guidelines