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I think it has to be CT scan immediately with loss of radiographer the next day
By lone headache i assume you mean classical presentation with no associated features right?
 
Based on information given the Hunt and Hess classification is grade I
However that is based on competence of examining physician
 
Hunt and Hess I has a mortality of say 30%
Add in some very subtle neurology and it's Hunt and Hess II with mortality of 40%
If they are a little drowsy ("expected" and may be "accepted as normal" after midnight) then it's Hunt and Hess III and now mortality is 50%
 
So very subtle variations in presentation profile and more importantly assessment can have significant repercussions
 
Risk of rebleed is approximately 5% in the first 24 hours so reasonable risk of a rebleed while waiting for the scan alone
 
Irrespective of CT scan result i think one has to reverse the warfarin as if scan normal a subarachnoid haemorrhage is presumed
 
So vitamin K + octaplex before the CT scan as i assume the warfarin would have been a short term course and no ongoing need for same
 
In terms of what to do post "normal" CT scan i guess MR angiogram early to look for an aneurysmal source
If no aneurysm then risk of rebleed becomes that of the general population
 
 
Adrian Moughty
SpR in Emergency Medicine