ABSTRACT
History A 45-year-old man presents to A&E complaining of a severe headache. The headache started 2 days prior to admission and has rapidly become more unbearable. He describes it as generalized headache associated with nausea and vomiting. He has felt feverish and shivery over the last 24 hours and has preferred to be alone in a dark, quiet room. Over the last week, he had been suffering with earache in his right ear associated with a serous discharge, but had not sought advice from the GP. His past medical history includes recurrent ear infections for which he is being followed up by an ENT surgeon. He takes no regular medication and has no allergies. He lives with his wife and two children all of whom are well. He works as an IT manager, drinks 34 units of alcohol per week and is a lifelong non-smoker.
