Tuesday, December 3, 2019

Sudden onset headache

Q: All of the following presents as a sudden-onset headache except

A) Subarachnoid hemorrhage (SAH)
B) Vertebral artery dissection
C) Acute angle-closure glaucoma
D) Pituitary apoplexy
E)  Herpetic meningitis

Answer: E

A sudden onset headache, particularly when it is described as the worst headache of life, and reaches maximal intensity within a few minutes, are all signs of serious central pathologies. The objective of this question is to highlight those headaches which are serious in nature but does not present in a classic 'sudden onset' presentations. These include herpetic or Lyme meningitis, cerebral venous sinus thrombosis, brain tumor, brain abscess, hypertensive encephalopathy, posterior reversible encephalopathy syndrome (PRES), and idiopathic intracranial hypertension.



Tabatabai RR, Swadron SP. Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes. Emerg Med Clin North Am 2016; 34:695.

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