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Medicine
A 35-year-old previously healthy woman suddenly develops a severe headache while lifting weights. A minute later she has transient loss of consciousness. She awakes with vomiting and a continued headache. She describes the headache as "the worst headache of my life." She appears uncomfortable and vomits during the physical examination. Blood pressure is 140/85, pulse rate is 100/min, respirations are 18/min, and temperature is 36.8degC (98.2degF). There is neck stiffness. Physical examination, including careful cranial nerve and deep tendon reflex testing, is otherwise normal. Which of the following is the best next step in evaluation?
CT scan without contrast
CT scan with contrast
Cerebral angiogram
Holter monitor
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