General

Case Study - Sudden on-set of worst headache ever

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3 Sep 2016 - General
 

A young women, with no previous medical or surgical history, no on any medication, was attending casualty department due to sudden onset of headache in the morning. She had the epsiode of sudden onset, the worst ever headache, "thunderclap" in nature, rate 10/10, after she ate her breakfast in the morning. There were no visual symptoms or any prodromal symptoms precede the headache. The headcahe was associated with nausea feeling, but no vomiting. There were no photophobia, bo neck stiffness, no fever. The headache was slowly improved over the day, but never fully recover. Patient was mentioning about having a lot of stressful events recently. The vital signs (respiratory rate, oxygen saturation, blood pressure, pulse and temperature) were satisfactory. Neurology examination (plus all other examination), were normal. b-HCG, and other blood tests were normal. What is your differential diagnosis ?? What are the important investigation you wish to do next??? 

Thanks for all the opinions, it is great to have some variety of opinions towards the management of this case. Yes, we should not be performing a lumbar puncture prior to imaging. This patient did had a CT-Brain first which showed no abnormality, pri...
 (Total 116 words)
Yes, "thunderclap in nature" headache described as the worst headache of her life would prompt a doctor to suspect subarachnoid hemorrhage (SAH). You Yi Hong ...
 (Total 123 words)
You Yi Hong Performing a lumbar puncture without getting an imaging test that will prove the absence of a mass lesion is a dangerous practice. Even if the patient has an atypical presentati...
 (Total 158 words)
A negative CT-Brain followed by a negative lumbar puncture should be sufficient to rule out the possibility of subarachnoid haemorrhage. The other possible alternative of non-contrast CT-Brain with CT angiography can rule out subarachnoid haemorrhage...
 (Total 107 words)
I understand You Yi Hong . However, if this is my personal patient, I'd still go for a Contrast-enhanced Cranial MRI with MRA because first, the patient presented with atypical features...
 (Total 124 words)
Yes, Marinelle Castro the most important cause that we need to rule out is subarachnoid haemorrhage or tiny leakage from the aneurysm. The fist investigation will be CT-Brain to rule out h...
 (Total 113 words)
The description of a thunderclap headache that's grade 10/10 will always make a healthcare provider consider the possibility of subarachnoid hemorrhage. This is usually seen on a Plain Cranial CT. However, for this case. The patient has neurologi...
 (Total 123 words)