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Subarachnoid hemorrhage — RCPSC IM MCQ

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HardNeurologySubarachnoid hemorrhageRCPSC IM

A patient presents with thunderclap headache three hours after onset. Expert-interpreted noncontrast CT is normal, but the history remains strongly suspicious for subarachnoid hemorrhage. What is the best next step?

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Correct answer: A — Use CTA or lumbar puncture under the local pathway

The best answer is “Use CTA or lumbar puncture under the local pathway”. A negative early CT lowers risk but does not end evaluation when clinical suspicion remains high unless a validated rule and high-quality CT pathway apply. CTA or lumbar puncture is selected through the local diagnostic strategy and shared discussion of tradeoffs.

Reference: Canadian Stroke Best Practices, emergency management of intracerebral hemorrhage: https://www.strokebestpractices.ca/recommendations/management-of-intracerebral-hemorrhage/emergency-management-of-intracerebral-hemorrhage