Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive, severe headache, often thunderclap in onset, associated with nausea, vomiting, and visual disturbances. History significant for hypercoagulable state, recent infection, pregnancy/puerperium, or oral contraceptive use. Symptoms may include focal neurological deficits, seizures, or altered mental status.
Clinical Examination Findings
Vitals: Monitor for hypertension or fever. General: Patient may appear distressed due to pain. HEENT: Funduscopic exam reveals papilledema suggestive of increased intracranial pressure. Neck: Check for nuchal rigidity. Skin: Assess for signs of systemic thrombosis or petechiae.
Treatment Protocol
Initiate therapeutic anticoagulation (e.g., LMWH or UFH) immediately, even in the presence of intracranial hemorrhage. Manage increased intracranial pressure with osmotic agents (mannitol/hypertonic saline) if indicated. Consider endovascular thrombolysis or mechanical thrombectomy for refractory cases. Monitor for seizure activity and initiate antiepileptic therapy if indicated.