BOF: 26
A 50-year-old female presents with a sudden onset
occipital headache followed by a decreased level of consciousness. On
examination she has neck stiffness and a positive Kernig’s sign. CT scanning
shows blood in the sub-arachnoid and intraventricular space.
The patient improves initially but 10 days following
admission her level of consciousness begins to deteriorate.
The next step in management would be:
a)
Decompression by lumbar puncture
b)
Lumbar puncture followed by high dose broad spectrum antibiotics until
cultures are available
c)
High dose dexamethasone
d)
CT scan followed by a ventricular jugular shunt
e)
Cisternal puncture for decompression
Answer:
d)
The patient has had a sub-arachnoid haemorrhage.
Deterioration coming on after an initial improvement is most likely due to the
development of secondary hydrocephalus due to blockage of CSF flow by blood. The
management would be CT scan to confirm the diagnosis followed by a procedure to
drain CSF.
Revision Tip
Revise subarachnoid haemorrhage
KEYS to SUCCESS in Medicine page 455-456
