GP CCE Cases · neurological-presentations
Thunderclap headache — CCE clinical encounter
CCE-style clinical encounter: a 43-year-old woman presenting with sudden-onset severe headache. The candidate must recognise the thunderclap pattern, arrange immediate CT head, interpret the result in context of timing, and plan LP if indicated.
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Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 43-year-old woman presents to the out-of-hours service with a severe headache that started suddenly two hours ago while watching television. She describes it as 'like being hit on the head'. She has no previous headache history, no fever, no focal neurological signs on examination. BP 152/94.
Objectives
- Recognise the thunderclap pattern and its significance. [1]
- Arrange immediate CT head without delay. [1] [2]
- Interpret the CT result in context of timing from onset. [2]
- Plan LP for xanthochromia if CT is negative but suspicion persists.
- Safety-net appropriately for discharge or transfer.
References2ShowHide
- [1]Masuhr F, Mehraein S, Einhäupl K Cerebral venous and sinus thrombosis. J Neurol, 2004.PMID 14999484
- [2]Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Lee JS, et al. High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ, 2010.PMID 21030443