A pain in the neck

A 41-year-old woman presented to the emergency department after developing severe neck pain while unloading groceries. The pain began at the base of her neck, radiated to the vertex of the skull, reached maximum intensity within 2–3 min, and was aggravated by head movement. Neurological examination was normal. Head CT showed focal hyperattenuation immediately anterior to the midbrain (figure 1) and angiogram showed no evidence of aneurysm (see online supplementary figure 1). Diagnosis: Perimesencephalic nonaneurysmal subarachnoid haemorrhage (PN-SAH). Originally described in 1985,1 PN-SAH has been reported in patients aged 3–70 years and accounts for roughly 10% of all SAH.2 Unlike SAH due to aneurysmal rupture, PN-SAH is thought to be due to a low-pressure venous bleed and usually causes a milder headache that builds over minutes rather than the classic thunderclap headache.1 2 Radiographically, the diagnosis of PN-SAH is suggested by...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: Headache (including migraine), Pain (neurology), Stroke, Ethics Images in emergency medicine Source Type: research