Does a patient with a thunderclap headache need a lumbar puncture?

摘要

A 37-year-old woman presents to the emergency department four hours after an acute onset of the "worst headache of her life" that began at rest. She experienced no loss of consciousness or neck pain. She has no history of intracranial disease or family history of cerebral aneurysms. Her vital signs are normal. No evidence of neurologic deficits is found on examination. Subarachnoid hemorrhage is on your differential diagnosis in this neurologi-cally intact patient. You consider the relevant work-up.