I Human Week 9 Case 26-Year-Old Female 5 6 122 lbs Presenting
with Increased Frequency of Severe Headaches
Patient Profile History of Present Illness (HPI)
❖ Name: Deborah Arnaudin Patient presents to the Emergency Department via EMS reporting a sudden,
Age: 26 Gender: Female 'thunderclap' onset of excruciating headache that began 45 minutes ago while
Chief Complaint: "The worst she was lifting a heavy laundry basket. She describes the pain as 10/10,
headache of my life." pulsating, and primarily occipital. This is distinct from her history of mild,
episodic migraines, which she describes as 3/10 and manageable with OTC
ibuprofen. Associated symptoms include nausea, two episodes of projectile
vomiting, and photophobia.
Past Medical History (PMH) & Social Current Medications & Allergies
, • PMH: Migraine without aura (diagnosed age 19). • • Medications: Ethinyl estradiol/norgestimate (Oral
Surgical: Appendectomy (2018). • Social: Non-smoker; Contraceptive Pill), Ibuprofen 400mg PRN for headaches
social alcohol use (1-2 drinks/week); works as a graphic Allergies: No Known Drug Allergies (NKDA).
designer. • Family History: Mother has hypertension;
Father has Type 2 Diabetes.
Vital Signs Physical Examination Findings
• Temp: 98.9°F • BP: 158/94 mmHg (Mild • General: Appears in acute distress, clutching head in a darkened
Hypertension) • HR: 102 bpm (Tachycardia) • room. • Neurological: Alert and oriented x3. Cranial nerves II-XII inta
RR: 20 bpm • SpO2: 99% on room air but patient exhibits mild pronator drift on the right. • Meningeal Sign
Positive Brudzinski’s sign (involuntary flexion of hips/knees upon
flexion of the neck) and positive Kernig’s sign (pain/resistance when
extending the knee with the hip flexed at 90°).
Clinical Pearl: Thunderclap Headache
Pathophysiology: A 'thunderclap' headache reaches peak intensity within 60 seconds. In the context of
sudden exertion, this is a hallmark sign of a Subarachnoid Hemorrhage (SAH), often caused by a
ruptured cerebral aneurysm.
Urgency: Immediate non-contrast CT imaging is mandatory. The sensitivity of CT for SAH is highest
(>95%) within the first 6 hours of symptom onset. If CT is negative but clinical suspicion remains high, a
lumbar puncture is the next diagnostic step to look for xanthochromia.
Diagnostic Imaging Results
Test Radiology Report
CT Head (Non-contrast) Finding: Hyperattenuating material noted within the basal cisterns, sylvian fissur
and cortical sulci. Impression: Acute Subarachnoid Hemorrhage (SAH). No
evidence of midline shift or hydrocephalus at this time. Urgent neurosurgical
consultation recommended.
with Increased Frequency of Severe Headaches
Patient Profile History of Present Illness (HPI)
❖ Name: Deborah Arnaudin Patient presents to the Emergency Department via EMS reporting a sudden,
Age: 26 Gender: Female 'thunderclap' onset of excruciating headache that began 45 minutes ago while
Chief Complaint: "The worst she was lifting a heavy laundry basket. She describes the pain as 10/10,
headache of my life." pulsating, and primarily occipital. This is distinct from her history of mild,
episodic migraines, which she describes as 3/10 and manageable with OTC
ibuprofen. Associated symptoms include nausea, two episodes of projectile
vomiting, and photophobia.
Past Medical History (PMH) & Social Current Medications & Allergies
, • PMH: Migraine without aura (diagnosed age 19). • • Medications: Ethinyl estradiol/norgestimate (Oral
Surgical: Appendectomy (2018). • Social: Non-smoker; Contraceptive Pill), Ibuprofen 400mg PRN for headaches
social alcohol use (1-2 drinks/week); works as a graphic Allergies: No Known Drug Allergies (NKDA).
designer. • Family History: Mother has hypertension;
Father has Type 2 Diabetes.
Vital Signs Physical Examination Findings
• Temp: 98.9°F • BP: 158/94 mmHg (Mild • General: Appears in acute distress, clutching head in a darkened
Hypertension) • HR: 102 bpm (Tachycardia) • room. • Neurological: Alert and oriented x3. Cranial nerves II-XII inta
RR: 20 bpm • SpO2: 99% on room air but patient exhibits mild pronator drift on the right. • Meningeal Sign
Positive Brudzinski’s sign (involuntary flexion of hips/knees upon
flexion of the neck) and positive Kernig’s sign (pain/resistance when
extending the knee with the hip flexed at 90°).
Clinical Pearl: Thunderclap Headache
Pathophysiology: A 'thunderclap' headache reaches peak intensity within 60 seconds. In the context of
sudden exertion, this is a hallmark sign of a Subarachnoid Hemorrhage (SAH), often caused by a
ruptured cerebral aneurysm.
Urgency: Immediate non-contrast CT imaging is mandatory. The sensitivity of CT for SAH is highest
(>95%) within the first 6 hours of symptom onset. If CT is negative but clinical suspicion remains high, a
lumbar puncture is the next diagnostic step to look for xanthochromia.
Diagnostic Imaging Results
Test Radiology Report
CT Head (Non-contrast) Finding: Hyperattenuating material noted within the basal cisterns, sylvian fissur
and cortical sulci. Impression: Acute Subarachnoid Hemorrhage (SAH). No
evidence of midline shift or hydrocephalus at this time. Urgent neurosurgical
consultation recommended.
