More headaches

A 26 year old man presents with a persistent, severe, throbbing occipital headache for 3 days and fever for 2 days. He was woken up by the headache.

He is otherwise asymptomatic and has never experienced a similar headache before. His medical, family and drug histories are completely unremarkable.

A full blood count is found to be normal.

Select Relevant Investigations
CT Brain (non contrast)

Performed

The CT scan appears normal, with no obvious mass lesions or features suggestive of intraventricular or subarachnoid haemorrhage.
Coagulation screen

Performed

INR: 1.0 (normal)
APTT: 28s (normal)
TT: 12s (normal)
Lumbar puncture

Performed

Appearance: uniformly blood stained
Spectrophotometry: xanthrochromia noted
Microscopy: Field full of RBC / hpf
Protein: 42 mg/dl
Glucose: 70 mg/dl (RBS: 120 mg/dl)
Gram stain: negative
CT angiogram brain

Performed

An intracranial aneurysm is noted in the region of the anterior communicating artery. No other abnormalities are noted.

Select Relevant Management
IV Antibiotics stat
Nimodipine
Sumatriptan
Endovascular treatment