ABC: časopis urgentne medicine (Jan 2016)
Headache as a sign of a serious disease: Case report
Abstract
AIM: To point to the importance of EMS physicians in recognizing symptoms of a headache as a sign of a serious illness. The case report shows that besides professionalism and skills of doctors, cooperation between a patient and a doctor have essential relevance. MATERIALS AND METHODS: Retrospective case report using the data from the protocols of the services that participated in the patient diagnosis and treatment. CASE REPORT: In the early evening, the Emergency Department Service receives a call from a female person, 54 years old. She complains of a severe headache that has lasted for two hours. She claims that this is the most serious headache in her life. She has taken the regular antihypertensive therapy, analgesic but the headache does not stop. Upon arrival of EMS team, the patient complains of a severe, occipital headache, neck pain and nausea. Anamnesis reveals that the patient is a doctor, and the fact that there is a positive family history of cerebrovascular diseases. Despite normal neurological status of the patient, transport by EMS was proposed in order to give the observation which she rejected as a colleague, a doctor, insisting on intramuscular therapy. After three hours, there was the second call from the husband of the same person. He stated vomiting and difficulties in communication. On going again and examination, somnolence, focal neurological deficit and rigidity of cervical spine were ascertained. The patient was transported to the neurological emergency department. The condition worsened rapidly, progressing to coma and that evening the patient was referred to the neurosurgery diagnosed intracranial hemorrhage. CT scan showed that it was a subarachnoid hemorrhage. CONCLUSION: An intense headache, never experienced before, like a 'thunder strike' is one of the key symptoms in the context of clinical features of SAH. It is equally important for EMS physicians to recognize a headache as a potential medical emergency and for a patient cooperation. In patients, who survive, severe disability usually remains and therefore the significance of cooperation at all levels is of crucial importance because it is often a difference between life and death, but also a difference in the quality of life of survivors.
