18th August 2024

A 34-year-old man is seen in A&E with collapse. He was with his girlfriend at the time

A 34-year-old man is seen in A&E with collapse. He was with his girlfriend at the time of onset and she reports he had been complaining of a new headache while they were walking around the shops. He then started vomiting and fell to the floor. He remained conscious throughout and has since vomited in the department. She reports that he is usually well. On examination, he has a left hemiparesis, left-sided neglect and is severely dysarthric. There is some neck stiffness and he appears to be becoming more drowsy.  His blood pressure is 170/100 mmHg and his heart rate is 55 bpm. On examination of his abdomen there are palpable masses in each flank and the liver is palpable 1cm below the lowest rib. CT confirms the diagnosis. Given the likely diagnosis, what is the most appropriate treatment to initiate?

Select the SINGLE most appropriate option from the list below. Select ONE option only.