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When a clear crystal makes a case crystal clear
  1. Rudolf Benz1,
  2. Max Züger2,
  3. Tamara Pung3,
  4. Evelyn Gallus4,
  5. Christian Weisshaupt5,
  6. Martin Krause6
  1. 1Consultant Haematologist and Laboratory Medicine, Department of Internal Medicine, Kantonsspital Münsterlingen, Switzerland and Department of Laboratory Medicine, Kantonsspital Münsterlingen, Switzerland
  2. 2Consultant Laboratory Medicine, Department of Laboratory Medicine, Kantonsspital Münsterlingen, Switzerland
  3. 3Consultant Neurologist, Clinic for Neurology, Kantonsspital Münsterlingen, Switzerland
  4. 4Registrar of Radiology, Department of Radiology, Kantonsspital Münsterlingen, Switzerland
  5. 5Senior Resident of Internal Medicine, Department of Internal Medicine, Kantonsspital Münsterlingen, Switzerland
  6. 6Head of the Department of Internal Medicine, Department of Internal Medicine, Kantonsspital Münsterlingen, Switzerland
  1. Correspondence to Dr Rudolf Benz, Department of Internal Medicine, Kantonsspital Münsterlingen, CH-8596 Münsterlingen, Switzerland; rudolf.benz{at}stgag.ch

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Sudden severe headache is often encountered and can be caused by many diseases, ranging from the harmless to life threatening. While CT and MR scans are mainly used to rule out intracranial bleeding and intracranial masses, lumbar puncture is performed to diagnose infections. We describe a case of subarachnoid haemorrhage (SAH) which was invisible on both CT and MRI but it was detected by examination of the CSF.

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A 56-year-old patient presented to our emergency department with a 3 week history of intense non-resolving frontal headache. His medical history was uneventful apart from two episodes of headache associated with flu-like symptoms and sinusitis. His family physician had started antibiotics assuming sinusitis. However, the pain had increased, sensitivity to light and noise developed, and he became severely incapacitated in his daily activities. The ear nose and throat specialist ordered a CT scan without contrast by which sinusitis was ruled out (the scan did not include the …

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