Severe headache - 9/10

Chief Complaint A 58 y/o female presented with an acute severe headache with nausea & weakness. She was taking Nisoldipine for htn, and stopped 15 days back. She explained headache as 9/10 as continuous & radiating to shoulder. History She had similar episode 1 week back, but never before. He had h/o Htn for past 5 years and is on medication for the same. No other past medical history. Vitals Blood pressure 160/95 mm Hg, Resp rate 22/min, HR 93 bpm, Temperature 98.2°F. Examination Visual field normal. Gait was normal. Neck and limb movements normal. Investigations CT at the same day was normal. Patient was admitted in the hospital with same headache for 2 days. CT brain after 2 days shows frontoparietal & right frontal convexal subarachnoid haemorrhage & with mild cortical swelling Treatment Please give your opinion on the case.



Pt is hypertensive and was on antihypertensives but stopped suddenly As we know calcium channel blockers are vasodilators and thus increases intracerebral pressure which gave way with withdrawal as SAH Yes bursting of any pre exiting aneurysm or av fistula is also an possibility Now treat as intracerebral hemorrhage or CVA

Thanx dr Saurabh Burkul

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* CVA ** SAH Needs further investigation and evaluation to conclude particularly CT angiography. Treatment as per CVA. Constant evaluation and regular monitoring advised.

Thanks Dr S Nigam

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Spontaneous subarachnoid hemorrhage ? Aneurysm rupture Adv Cerebral angiography

Headache due to subarchnoid hhg in frontoparietal & right frontal combexal Hypertension Opinion of neurosurgeon Repeated mri brain Venogram

Was nuchal rigidity checked during clinical examination? If yes.. what was the status?

Hypertension ? Aneurysm rupture As there is subarachnoid hemorrhage.. MRI brain Neurolosurgeon opinion..

Need to evaluate more towards rupture aneryms Need initially to control htn Advice 4 vessel cerebral angiography


Cva c_ess. Hypertension Try anti hypertensives with pph

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