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Severe Headache 

Severe Headache
Severe Headache
Acute Care Casebook

Aman Shah


This case highlights the clinical presentation and diagnostic workup of a subarachnoid hemorrhage (SAH) in an emergency department setting. Given the high morbidity and mortality associated with this diagnosis, clinicians must have a high index of suspicion when patients present with an acute onset, severe headache. While computed tomography of the head is the best initial diagnostic test, lumbar puncture should be performed if the imaging is equivocal or negative and the clinical concern for SAH persists. After SAH is diagnosed, prompt consultation and co-management with neurosurgery should occur, in addition to strict blood pressure control and efforts to reduce intracranial pressure. Trauma is the most common cause of SAH while aneurysmal rupture is the leading cause of atraumatic SAH.

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