Sun28November0440PM 36

A 25-year-old woman is admitted with abrupt onset of a severe occipital headache whilst decorating at home. This was associated with vomiting and transient loss of consciousness.

On examination her Glasgow coma scale (GCS) score is 15, she is afebrile, has a blood pressure of 146/84 mmHg and a pulse rate of 70 beats/minute. Her physical examination is normal apart from an abrasion over her right temple.

What is the single most appropriate initial management?

(Please select 1 option)

Carboxyhaemoglobin level

Admit for head injury observation

Lumbar puncture

Computed tomography (CT) brain scan Correct

Skull x ray

Explanation

The history of sudden onset of severe headache in a young woman is suggestive of subarachnoid haemorrhage. The associated vomiting and loss of consciousness add weight to this.

The investigation of choice is a CT scan of the brain looking for subarachnoid blood.

If this is normal a lumbar puncture should be performed as a CT scan will miss approximately 10% of cases of subarachnoid haemorrhage.

Answer Statistics

1

3%

2

4%

3

2%

4

92%

5

1%

Times answered: 281