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Suspected subarachnoid haemorrhage — SCE Acute Medicine MCQ

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ModerateNeurology and ophthalmologySuspected subarachnoid haemorrhageSCE Acute Medicine

A 73-year-old woman presents with sudden severe headache described as being hit on the back of the head. CT head performed 10 hours after onset is normal. She remains photophobic and has neck stiffness. What is the most appropriate next investigation?

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Correct answer: E — Lumbar puncture for xanthochromia after appropriate timing

Thunderclap headache with meningism remains concerning for subarachnoid haemorrhage despite a normal CT, particularly when imaging is not performed very early. LP for xanthochromia is appropriate after suitable timing if suspicion remains. Discharge or migraine treatment alone would miss a potentially fatal diagnosis.

Reference: NICE CKS Headache; National Clinical Guideline for Stroke 2023