Q:

A 34 year old female presented with vomiting preceded by an occipital headache of acute onset. Examination: conscious and alert with photophobia but no neck stiffness. CT: normal. What is the most appropriate further management?

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A 34 year old female presented with vomiting preceded by an occipital headache of acute onset. Examination: conscious and alert with photophobia but no neck stiffness. CT: normal. What is the most appropriate further management?


  1. CT brain with contrast
  2. CT brain with contrast
  3. CSF exam
  4. Cerebral angio
  5. MRI brain

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The key is C. CSF exam. [Probable subarachnoid hemorrhage. CT may not show any abnormality in early stage in some instances and in that case we shall do CSF examination 12 hours later to see xanthochromia].

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