A 37-year-old woman has sudden severe headache during exercise with vomiting and meningism. BP is 168/94, CT head performed 10 hours after onset is

Question

A 37-year-old woman has sudden severe headache during exercise with vomiting and meningism. BP is 168/94, CT head performed 10 hours after onset is read as normal, and neurological examination is intact. She remains photophobic. What is the most appropriate next step?

Accepted Answer

Pursue lumbar puncture or CT angiography for SAH evaluation

Answer

Start oral triptan and outpatient neurology referral

Answer

Reassure because the CT is normal after six hours

Answer

Discharge with migraine treatment

Answer

Give alteplase for occult stroke

Subarachnoid haemorrhage evaluation after negative CT — RCPSC EM MCQ

A 37-year-old woman has sudden severe headache during exercise with vomiting and meningism. BP is 168/94, CT head performed 10 hours after onset is read as normal, and neurological examination is intact. She remains photophobic. What is the most appropriate next step?