Oli Flower presents a case of headache with an unusual diagnosis. Hopefully thought provoking. The slides can be seen separately on www.intensivecarenetwork.com and the links to relevant resources can be found there too. This was presented at last years BCC in Daydream island

1. think outside the box.

2. ... 61 year old lady
sudden onset
acute severe headache
history of migraines
mild nausea
no other symptoms
mild neck stiffness

3. 36.5
no prescribed meds
no focal deficits
no meningism

5. LPClear
<10 white cells
glucose 6 mmol/L
Pressure 14 cm CSF
no red cells
xanthochromia negative

6. .in or out?
what next?

7. RCVS

8. history

9. angiogram

13. CSF

14. RCVS

15. RCVS

20. RCVS

21. RxmS

22. think of it
identify & stop causes
don’t give steroids
consider nimodipine
consider angiographic interventions
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