Thunderclap Headache: A Case of Subarachnoid Hemorrhage
A branching clinical case simulation for a patient presenting with thunderclap headache during exercise, now with neck stiffness and photophobia. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 5hard20 min6 stages
- Patient
- 48 years, female
- Presenting complaint
- Thunderclap headache during exercise, now with neck stiffness and photophobia
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
You are the junior doctor in a district general hospital emergency department. SBAR from triage: Sarah Mitchell, 48-year-old woman, presented with sudden, severe headache during a zumba class 6 hours ago. She vomited twice and now has neck stiffness and photophobia. CT head has been performed and reported as normal by the radiologist. GCS 15, no focal neurology. Please assess and manage this patient.
What this case teaches
Recognise thunderclap headache as an emergency; understand the sensitivity of CT and when lumbar puncture is needed; start nimodipine; refer to neurosurgery.
How the case unfolds
- 1Focused History TakingHistory
- 2ExaminationExamination
- 3InvestigationsInvestigations
- 4Diagnosis and ReferralDiagnosis
- 5Initial Medical ManagementTreatment
- 6Monitoring and TransferMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.