Spontaneous parieto-occipital haematoma: lessons for the primary care clinician

This case is intended to serve as a learning tool for all clinicians working in primary care. Headache is a commonly encountered problem in primary care and most cases do not mandate urgent transfer to secondary care. However, in this particular patient, there was focal neurology as well as a coital history of headache, both of which collectively mandated further investigation. She was diagnosed with a spontaneous parieto-occipital haemorrhage. On reflection, it is important to note that, despite this haemorrhage, the patient remained well enough to present to primary care and was still able to maintain a Glasgow Coma Scale score of 15/15. This case highlights two important areas of learning which could be useful to all healthcare professionals evaluating headaches. Firstly, any new focal neurology such as blurring of vision should prompt further investigation. Secondly, all healthcare professionals evaluating a sudden-onset headache should ask about whether the headache was coital or not, as this is very easy to ask and may prove to be very diagnostically useful. ### Presenting complaint A 44 year old woman presented to her GP on a morning walk-in clinic, complaining of an 18-hour history of severe headache which was spreading from the posterior to the anterior aspect of her head. She mentioned that this …