An elderly, hypertensive patient presented with sudden onset headache, vomiting, neck rigidity without focal neurological deficit. Diagnosis:(AIIMS November 2013. May 2013)
## **Core Concept**
The patient's presentation of sudden onset headache, vomiting, neck rigidity without focal neurological deficit is suggestive of a condition affecting the central nervous system, likely related to the cerebrovascular system given the patient's history of hypertension.
## **Why the Correct Answer is Right**
The symptoms described are classic for a **subarachnoid hemorrhage (SAH)**, which is often due to the rupture of an **aneurysm** or less commonly, an **arteriovenous malformation (AVM)**. The sudden onset headache, often described as "the worst headache of my life," along with vomiting and neck rigidity (meningismus), are hallmarks of SAH. The absence of focal neurological deficits does not rule out SAH, as the bleeding can be diffuse within the subarachnoid space. Hypertension is a risk factor for aneurysm formation and rupture.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, incorrect options might include conditions like meningitis, encephalitis, or cerebral venous sinus thrombosis, which can present with headache and neck stiffness but usually have additional distinguishing features such as fever (meningitis, encephalitis) or a more gradual onset.
- **Option B:** Similarly, not provided, but could potentially represent other diagnoses like ischemic stroke, which usually presents with focal neurological deficits.
- **Option D:** Without the specific option provided, it's hard to give a detailed explanation, but generally, conditions like brain tumors or cerebral edema might present with headache and vomiting but typically have other associated symptoms or signs.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that a **non-contrast CT scan** is the initial diagnostic test of choice for suspected SAH because it can detect fresh blood in the subarachnoid space. A lumbar puncture (LP) may be performed if the CT is negative but clinical suspicion remains high, looking for blood or bilirubin in the cerebrospinal fluid.
## **Correct Answer:** . **Subarachnoid hemorrhage**