Review this presentation by Dr Martin Bicket with Dr Shona McIntyre for HMO teaching.

Apologies for the scratchy lofi audio quality – subtitles have been transcribed for clarity and it is recommended that you use this feature.

38min

Key points

1. Classic history for subarachnoid haemorrhage (SAH) is sudden onset, ‘thunderclap’, worst onset headache and clinicians should be sensitive to not lead the patient to include nor exclude these features
2. Lumbar puncture cannot yet be completely excluded from the workup of (SAH) after negative CT brain, despite the Perry study; consult with senior staff
3. Presence of risk factors like increasing age, immunosuppresion, malignancy, autoimmune or connective tissue disorders should lower the threshold for investigation in general
4. Consider lumbar puncture in cases of suspected viral meningitis, particularly for those patients who are not progressing
5. CT brain still has utility in general, even in the younger patient – consult with seniors as practice variation exists
6. Do not forget extracranial causes of headache like giant cell arteritis / temporal arteritis and glaucoma