NREMT Paramedic Cognitive ExamMedicalEasy
A 68-year-old male presents with sudden onset of severe, unilateral headache, photophobia, and a stiff neck. He describes the headache as 'the worst headache of my life.' His Glasgow Coma Scale (GCS) is 14 (E4, V4, M6). Vital signs are BP 160/90 mmHg, HR 70 bpm, RR 16 bpm, SpO2 97% on room air. Which of the following conditions is most consistent with this presentation?
- AIschemic stroke
- BMigraine headache
- CSubarachnoid hemorrhage (SAH)
- DTension headache
Show answer & explanationAnswer & explanation
Correct answer: C. Subarachnoid hemorrhage (SAH)
The sudden onset of a 'thunderclap' headache, described as the 'worst headache of my life,' combined with photophobia and nuchal rigidity (stiff neck), is highly indicative of a subarachnoid hemorrhage (SAH). SAH is a medical emergency requiring immediate attention.
Why the other options are wrong
- A. Ischemic stroke typically presents with focal neurological deficits (e.g., weakness, speech changes) rather than isolated severe headache, photophobia, and nuchal rigidity, although headache can sometimes occur.
- B. While migraines can cause severe, unilateral pain and photophobia, they rarely present with a sudden 'thunderclap' onset or nuchal rigidity in the absence of meningitis or SAH.
- D. Tension headaches are typically mild to moderate, bilateral, and do not present with sudden severe pain, photophobia, or nuchal rigidity.
Subarachnoid Hemorrhage (SAH)
Bleeding into the subarachn space, the area between the arachnoid membrane and the pia mater surrounding the brain. It is often caused by a ruptured aneurysm.
- Sudden onset, 'thunderclap' headache
- Often described as 'worst headache of my life'
- Nuchal rigidity (stiff neck)
- Photophobia, nausea/vomiting, altered mental status
Memory trick: Headache Clues: Sudden, Severe, Stiff = SAH