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Subarachnoid haemorrhage headache — SCE Neurology MCQ

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HardHeadacheSubarachnoid haemorrhage headacheSCE Neurology

Non-contrast CT confirms spontaneous subarachnoid blood in the basal cisterns after a thunderclap headache. The patient is stable. Which investigation should follow promptly to identify a treatable source?

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

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Correct answer: E — CT angiography of the intracranial arteries, after checking contraindications, in this presentation

The best answer is “CT angiography of the intracranial arteries, after checking contraindications, in this presentation”. Once CT confirms SAH, CT angiography is the recommended next test to identify an aneurysm and plan definitive treatment. “Lumbar puncture for xanthochromia despite already diagnostic CT” is plausible in a different neurological context, but the decisive findings here argue against it. “Carotid Doppler ultrasonography” is plausible in a different neurological context, but the decisive findings here argue against it. “Routine electroencephalography” is plausible in a different neurological context, but the decisive findings here argue against it. “Nerve-conduction studies” is plausible in a different neurological context, but the decisive findings here argue against it.

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