Advanced Medical Life Support (AMLS)

What condition is most likely indicated by a "thunderclap" headache, nausea, blurred vision, and elevated blood pressure?

1. Brain abscess

2. Ischemic stroke

3. Epidural hematoma

4. Subarachnoid hemorrhage

The correct answer is: Subarachnoid hemorrhage

A "thunderclap" headache, often described as the worst headache of someone's life, is a classic symptom associated with a subarachnoid hemorrhage. This type of headache typically appears suddenly and intensely, often leading patients to seek immediate medical attention. The presence of nausea and blurred vision further supports the diagnosis, as these symptoms can arise due to increased intracranial pressure or irritation of the meninges caused by blood in the subarachnoid space. Elevated blood pressure can also be observed as a response to acute pain or in reaction to the neurologic emergency of a hemorrhage. In contrast, conditions such as a brain abscess, ischemic stroke, and epidural hematoma have different presentations and underlying mechanisms. A brain abscess would likely present with fever and localized neurologic deficits, while an ischemic stroke typically involves sudden weakness or numbness, speech difficulties, and does not usually present with a thunderclap headache. Epidural hematomas can cause a rapid decline in conscious levels following a traumatic event, often coupled with lucid intervals, rather than the initial sudden headache with nausea and blurred vision typical of a subarachnoid hemorrhage. Thus, the combination of symptoms strongly points towards subarachnoid hemorrhage as