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Thunderclap headache with possible subarachnoid haemorrhage — RCPSC EM MCQ

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HardNeurological emergenciesThunderclap headache with possible subarachnoid haemorrhageRCPSC EM

A 38-year-old woman presents with the worst headache of her life that reached maximal intensity in one minute. Non-contrast CT head performed 10 hours after onset is normal. She remains photophobic with neck stiffness and has no focal deficit. What is the most appropriate next step?

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Correct answer: E — Proceed with lumbar puncture or CT angiography based on local subarachnoid haemorrhage pathway and shared risk discussion

A normal CT beyond the early high-sensitivity window does not reliably exclude subarachnoid haemorrhage. Further evaluation with LP or CTA, depending on institutional pathway and patient factors, is appropriate.

Reference: CAEP headache and subarachnoid haemorrhage practice; Ottawa SAH Rule literature