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Suspected subarachnoid hemorrhage — ABEM Board MCQ

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ModerateNeurological emergenciesSuspected subarachnoid hemorrhageABEM Board

A 44-year-old woman presents as triage level 2 with sudden thunderclap headache during exercise. Neurologic exam is normal. Noncontrast head CT performed 9 hours after onset is negative. Which of the following is the most appropriate next step in management?

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Correct answer: E — Perform lumbar puncture or CT angiography after shared decision-making

After a negative CT performed more than 6 hours from thunderclap onset, additional testing is needed if concern for subarachnoid hemorrhage remains.

Reference: ACEP Clinical Policy: Acute Headache; ABEM EM Model