NREMT Paramedic Cognitive ExamMedicalMedium
A 68-year-old male presents with sudden onset of severe, unilateral headache, photophobia, and a stiff neck. He reports a history of hypertension. His Glasgow Coma Scale (GCS) is 14 (E4, V4, M6). Vital signs are BP 180/100 mmHg, HR 60 bpm, RR 16 bpm, SpO2 98% on room air. Pupils are equal and reactive. What is the most likely cause of his symptoms?
- ASubarachnoid hemorrhage
- BIschemic stroke
- CMigraine headache
- DTension headache
Show answer & explanationAnswer & explanation
Correct answer: A. Subarachnoid hemorrhage
The sudden onset of a 'thunderclap' headache, stiff neck, photophobia, and elevated blood pressure in a patient with a history of hypertension strongly suggests a subarachnoid hemorrhage. While ischemic stroke can cause neurological deficits, a sudden severe headache and nuchal rigidity are less typical primary presentations.
Why the other options are wrong
- B. Ischemic stroke usually presents with focal neurological deficits, and headache is often not the primary or most severe symptom, nor does it typically cause nuchal rigidity.
- C. Migraines typically have a slower onset and may have auras, but sudden onset and nuchal rigidity are less characteristic.
- D. Tension headaches are usually diffuse, mild to moderate, and do not present with sudden onset severity or nuchal rigidity.
Subarachnoid Hemorrhage (SAH)
Bleeding into the subarachnoid space, often caused by a ruptured aneurysm, leading to sudden severe headache and meningeal irritation.
- Often described as the 'worst headache of my life.'
- Can cause nuchal rigidity, photophobia, and altered mental status.
- High mortality and morbidity; requires rapid diagnosis and treatment.
Memory trick: SUDDEN THUNDER in the BRAIN means SAH!