Sudden onset of vomiting as a presentation of perimesencephalic subarachnoid haemorrhage.
Subarachnoid haemorrhage (SAH) makes up 1% of all attendances for acute severe headache to emergency departments, but other less common presentations may be seen. A 28-year-old man presented to the ED complaining of a 24-h history of nausea and vomiting of sudden onset, but without headache. The patient also described mild photophobia and neck stiffness. A computed tomography scan revealed perimesencephalic blood, and a subsequent angiogram was negative. This appearance is seen in cases of non-aneurysmal SAH, which often occur in younger, male, normotensive patients, and give rise to few warning symptoms. A high index of suspicion should be maintained for SAH, even in the absence of headache.
Caesar
Ben
B
Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland.
Middleton
Paul M
PM
Watkins
Laurence D
LD
D000328:Adult; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000209:etiology*