Case of the week 23/01/14

A 64 year old man presents with sudden severe left sided headache and immediately vomited twice.  He felt dizzy but there was no aura or visual disturbances.  He has a previous history of migraine for which he takes Migraleve.  The current headache is much more severe and he has never vomited with his usual attacks of migraine.  He has a 2 year history of hypertension for which he is prescribed Ramipril by his GP.

On examination,

GCS 15/15

Pyrexial 37.8, pulse 80 reg, BP 170/100 mmHg

Irritable and felt dizzy on movement of head

Fundi normal, no neck stiffness, no focal neurological signs

Symmetrical reflexes, plantars down going

Rest of physical examination was normal

Questions

What are the possible diagnosis?

What is your management?

Further Educational Activity

Now complete this doctors.net module on Acute Headache:

http://www.doctors.net.uk/ecme/wfrmNewIntro.aspx?moduleid=1559