ZyraDoc #22 - August 23, 2026

A 45-year-old woman presents with a sudden-onset 'thunderclap' headache described as the worst headache of her life, accompanied by nausea, neck stiffness, and photophobia.

Physical examination shows nuchal rigidity and blood pressure of 172/98 mmHg, without focal neurological deficits.

A non-contrast head CT performed 3 hours after symptom onset is entirely normal, leading the junior physician to prepare for discharge with oral triptans.

Case Summary

Clinical Focus:

A 45-year-old female presents with classic symptoms of aneurysmal subarachnoid hemorrhage (SAH) and a normal initial non-contrast head CT.

Diagnostic Features of Subarachnoid Hemorrhage:

Sudden-onset, maximal intensity 'thunderclap' headache reaching peak intensity within seconds
Meningeal signs: Neck stiffness (nuchal rigidity), photophobia, vomiting
Aneurysmal rupture origin in over 80% of non-traumatic cases

A normal non-contrast head CT does not fully exclude SAH; diagnostic lumbar puncture is mandatory if CT is negative or equivocal.

Here is the Management Strategy:

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