ABSTRACT
A 29-year-old man from New Zealand was on holiday in London. While passing urine he developed a sudden-onset occipital headache that came on over 1–2 seconds. At the onset of the headache, the patient described hearing a loud banging noise in both ears. He collapsed to the floor and was unable to stand up. He attempted to use his mobile phone to call for help but found that he was unable to move his right arm, which he described as feeling ‘heavy and numb.’ He developed slurred speech, blurring of vision and vomiting. He was found by a relative who called the ambulance service. His past medical history included migraines, which he said were typically left-sided posterior headaches preceded by a visual aura. He took no regular medications. There was no family history of intracranial bleeding or polycystic kidney disease. The patient worked as a dog groomer. He had never smoked, occasionally drank alcohol and denied any recreational drug use.
