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Situation Judgement Test: No 26

60 year old Woman presents to ED with a history of a sudden onset headache after waking, nausea no vomitting.

Pain score 10/10. Past medical history was unremarkable.

On examination she is alert (CGS 15) No focal neurology

  • CT is done. See the next slide
  • What is the diagnosis
What is the diagnosis
Subarachnoid Haemorrhage Extradural Haemorrhage Subdurral Haemorrhage
It was a Subarachnoid Haemorrhage. In this instace it was a Perimesencephalic Haemorrhage
This is non traumatic, non aneurysmal.
However you should order CT angio to rule out posterior circulation aneurysm.
  • You can see the area of haemorrhage here
  • More Information

Subarachnoid can be differentiated from other bleeds by a few points in the history the main one being the sudden onset headache.

We call this a thunderclap headache.

Patients will talk about the worst headache they've ever had and it will come on rapidly, like being hit in the head with a spade.

Hear this, think thunderclap and Subarachnoid.

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