A real headache

A 32 year old man presents with a progressively worsening left sided throbbing headache for 1 week.

He did not experience fever, nausea, photophobia, phonophobia or diurnal symptoms. There was no associated limb weakness or sensory symptoms.

His medical history is unremarkable, with no history of chronic headaches.

Select Relevant Investigations
Full Blood Count

Performed

WBC/DC: 7,000/mm3
N: 71%, L: 25%

Hb: 13.3 g/dl
PCV: 40 %

Platelets: 400,000/mm3
CT Brain

Performed

The CT scan of the brain shows an area of low attenuation in the left parietal lobe. There is no evidence of midline shift and the ventricles appear normal.
MR Angiography

Performed

MRA demonstrates stenosis of the left internal carotid artery (L/ICA) just above the carotid bifurcation. A concomitant T1 weighted axial MRI demonstrates a semilunar hyperintense signal suggestive of an intramural hematoma in the stenosed region.
ECG

Performed

The ECG appears normal.

Select Relevant Management
Heparin
Warfarin
Statins
Carotid graft replacement