iatroX Rounds #2
The clues
- 1
A 44-year-old woman presents to A&E with sudden severe headache.
- 2
The headache came on abruptly, described as the 'worst of her life', while she was at work.
- 3
She has a history of treated hypertension but is otherwise healthy.
- 4
On examination she is photophobic and vomits once in the department.
- 5
A non-contrast CT head shows hyperdensity within the basal cisterns.
- 6
Lumbar puncture performed 12 hours after symptom onset reveals xanthochromia.
Subarachnoid haemorrhage is bleeding into the subarachnoid space, most often due to ruptured berry aneurysm. Thunderclap headache, photophobia and meningeal signs should raise clinical suspicion, especially when CT shows blood in the cisterns and lumbar puncture demonstrates xanthochromia.
- Thunderclap headache (sudden and severe)
- Photophobia and vomiting
- Xanthochromia on lumbar puncture
- Often in patients with hypertension or vascular risk
for education and entertainment. not medical advice.