QuestionSBA
QuestionChoice
This is bleeding into the outermost meningeal layer. It most commonly occurs around the frontal and parietal lobes. Risk factors include old age, alcoholism and anticoagulation, none of which are present in this patient. There is a gradual onset of symptoms over hours to days, and there may be fluctuating confusion. This is therefore not the correct answer.
10008203
d
Subdural haemorrhage
QuestionChoice
This is the correct answer as it best matches the presentation. A subarachnoid haemorrhage would present as a sudden onset ‘thunderclap’ headache. It usually occurs after exercise and it is more common in smokers.
10008200
a
Subarachnoid haemorrhage
QuestionChoice
An intracerebral (or intraparenchymal) haemorrhage is a collection of blood within the substance of the brain. It can be caused by hypertension, a vascular lesion, trauma, brain tumour, or infarct. Patients will present similarly to an ischaemic stroke. This answer is not correct as it does not reflect the presentation described above.
10008204
e
Intracranial haemorrhage
QuestionChoice
An extradural haemorrhage is characterised by bleeding between the outer dura mater and the inner surface of the skull. The most common source of bleeding is a tear of the middle meningeal artery following a head injury. There is typically a brief loss of consciousness, followed by regaining of normal consciousness level (the lucid interval), with subsequent deterioration of consciousness and headache. This patient did not experience head trauma, and there is no loss of consciousness.
10008201
b
Extradural haemorrhage
QuestionChoice
A stroke occurs when the brain is deprived of oxygen. There are two types of stroke; ischaemic and haemorrhagic. They are more common in older people and present with sudden onset of motor weakness, speech impairment, visual field defects and balance problems. This is not in line with the scenario and therefore not the right answer.
10008202
c
Stroke
Concept
Chapter
2693
4193
Subarachnoid haemorrhage
Topic
141
Neurology
14187
A 45-year-old woman presents to A&E with a severe, sudden-onset headache, nausea, and vomiting. She had just finished a vigorous fitness class when the headache came on. She describes this as being ‘the worst headache that she’s ever experienced’.

She has no previous medical history and is not on any regular medication. She does not drink alcohol but she smokes 12 cigarettes a day and has done so since the age of 20.

Which of the following is the most likely diagnosis?
a