Intended for healthcare professionals

Endgames Spot Diagnosis

An unusual cause of headache

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.k1933 (Published 04 April 2019) Cite this as: BMJ 2019;365:k1933
  1. Omed Amin, foundation year 2 doctor,
  2. David C Howlett, consultant radiologist
  1. Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, UK
  1. Correspondence to O Amin omedamin{at}doctors.org.uk

A 64 year old woman presented to the emergency department with a history of sudden onset severe generalised headache after waking, associated with nausea. She had no medical history. On examination, the pain had not eased but she appeared alert with no other discernible features. She underwent a computed tomography scan of the head (fig 1). What is the diagnosis, and are further investigations warranted?

Fig 1

Axial unenhanced computed tomography section at the level of the pons

Answer

Perimesencephalic subarachnoid haemorrhage …

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