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Subarachnoid haemorrhage after negative delayed CT — RCPSC EM MCQ

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HardNeurological emergenciesSubarachnoid haemorrhage after negative delayed CTRCPSC EM

A patient presents 14 hours after a thunderclap headache with persistent meningism. Neurologic examination is normal and a technically adequate non-contrast CT is negative. What is the next diagnostic step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Continue SAH evaluation with LP or CTA using the local pathway and shared decision-making

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · B = shown as D · C = shown as E

A accounts for reduced delayed-CT sensitivity and pathway-dependent trade-offs. B overextends early-CT evidence. C defers a dangerous diagnosis. D does not assess SAH. E cannot exclude an intracranial aneurysm or hemorrhage.

Reference: Emergency Care BC, Subarachnoid Hemorrhage—Diagnosis: https://emergencycarebc.ca/clinical_resource/clinical-summary/subarachnoid-hemorrhage-diagnosis/