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Step 1: View clinicals

A 23 year old man developed a severe generalized headache, which was sudden in onset, pulsating in nature, exacerbated by bright light, and which made him feel nauseous. The headache was preceded by worsening scintillating zigzags in both visual fields, which lasted for around 20 minutes. He presents 2 hours later, with no sign of resolution. Three months ago, he experienced a similar, but milder episode. His medical history is otherwise unremarkable, while he does not smoke, drink, or use recreational drugs.

Step 2: Order all relevant investigations

CSF Full Report & Culture

Appearance: clear Polymorphs: nil (< 5) Gram stain: negative Glucose: 70 mg/dL (50 - 80) Protein: 50 mg/dL (15 - 60)

CT Brain

The CT scan appears completely normal, with no evidence of hemorrhages, or mass lesions.

Carotid Duplex Scan

No abnormalities were detected.

Slit Lamp Examination

No abnormalities noted.

Step 3: Select appropriate management

Oxygen via Face Mask

Score: ★★☆