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017 A Real Headache

Situation

A 60 year old woman had a SAH, the ECG was very abnormal

Background

Patient presented with vomiting and a bad headache for 1 week. Admitted to medics who then diagnosed a massive SAH on CT. In retrospect the ED ECG did give a clue to ICH by showing massive and strange T wave inversions

Assessment

This patient may or may not have emphasised the vomiting (+ a bit diarrhoea too) over her headache thus misleading the ED clinician. But her ECG which looked almost exactly like this one from litfl:

should have triggered suspicion of an ICH if she reported any neurological symptoms at all.

Recommendation

Be aware that massive TWI can be caused by ICH



PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group


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