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Subarachnoid haemorrhage — SCE Neurology MCQ

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ModerateStrokeSubarachnoid haemorrhageSCE Neurology

A 36-year-old woman presented with a thunderclap headache reaching maximum intensity in seconds during exertion. On examination, neck stiffness developed and fundoscopy showed subhyaloid haemorrhage. Initial investigations showed: CT showed blood in basal cisterns; CTA showed anterior communicating aneurysm. What is the most appropriate management?

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Correct answer: C — Urgent neurosurgical aneurysm securing and nimodipine

Urgent neurosurgical aneurysm securing and nimodipine is the best answer because the vignette describes Subarachnoid haemorrhage: sudden maximal headache with cisternal blood indicates aneurysmal SAH. High-dose glucocorticoids with urgent visual protection is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Urgent neurosurgical assessment and Intravenous immunoglobulin with respiratory monitoring are less appropriate because they would require different localisation, timing or test findings; Withdrawal of overused analgesics with headache support would fit a different syndrome. Clinical pearl: migraine does not peak instantly with meningism and cisternal blood.

Reference: NICE NG128; National Clinical Guideline for Stroke; DVLA Assessing fitness to drive