Question

56 year old woman comes to ER due to severe HA that is non responsive to analgesics. Started 4hr ago and rapidly worsened over several minutes. Sx include photophobia and vomiting and gauge discomfort in neck and back. Never had a HA this bad. Currently has HTN. She is an architect and reports high stress. Temp nml, BP high, pulse fine and regular. Pupils and extra ocular moments normal. Mild neck stiffness and normal DTR. Babinski absent. non contrast CT scan head normal. Best next step

- lumbar puncture
SAH d/t sudden onset (MC from berry aneurysms resulting in severe sudden pain, N/V, meningismus

-urgen noncontrast CT for any pt with such HA. May show blood. Very high sensitivity in first 6hr. If negative, lumbar puncture should be performed in all pt with a high level of concern. high opening pressure, xanthochromia, and high RBC

Answer 1

The best next step for this patient is to perform a lumbar puncture to check for subarachnoid hemorrhage (SAH).

Step-by-step explanation:

The best next step for this patient is to perform a lumbar puncture to check for subarachnoid hemorrhage (SAH). SAH is most commonly caused by berry aneurysms and presents with sudden severe headache, vomiting, neck stiffness, and back pain. While the non-contrast CT scan of the head may not show any abnormalities in the first 6 hours, a lumbar puncture can help confirm the presence of SAH by measuring high opening pressure, presence of xanthochromia (yellow discoloration of the cerebrospinal fluid due to the breakdown of red blood cells), and high red blood cell count.