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Possible subarachnoid haemorrhage — RCPSC EM MCQ

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HardNeurological emergenciesPossible subarachnoid haemorrhageRCPSC EM

A 42-year-old woman has a thunderclap headache that reached maximum intensity in 30 seconds. CT head performed 10 hours after onset is normal. She is photophobic and has neck stiffness. What is the most appropriate investigation?

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Correct answer: B — Lumbar puncture or CT angiography to assess for subarachnoid haemorrhage

A normal CT within 6 hours can be highly sensitive in selected patients, but this CT was at 10 hours with persistent meningism. Further evaluation with LP or CTA is needed depending on local pathway.

Reference: CAEP acute headache practice; Canadian emergency medicine evidence