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A 25-year-old Indian woman presented to the emergency department with sudden onset of moderately severe holocranial headache. She was nauseated, but had no vomiting, neck stiffness or photophobia. She had been previously well and took the combined oral contraceptive pill. There was no family history of thrombosis. On examination, she was apyrexial with a Glasgow coma scale score of 15. There were no focal neurological signs. Routine blood tests were normal and her MRI scan of brain was initially reported as normal (figure 1). Her headache persisted and 2 days later she had a generalised tonic-clonic seizure. Repeat MRI scan of brain showed haemorrhage in the right temporal lobe (figure 2). Due to further convulsive …
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