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Standard teaching is that lumbar puncture (LP) is essential in patients with suspected subarachnoid hemorrhage (SAH) despite normal head computed tomography (CT) scans. Researchers prospectively enrolled 3132 consecutive neurologically intact patients older than 15 who underwent head CT with third-generation multislice scanners to evaluate nontraumatic acute headache or headache with syncope at 11 tertiary emergency departments in Canada from 2000 to 2009. LP was performed at the discretion of the treating physician. Experienced radiologists who were blinded to the study interpreted all CT scans. SAH was defined by subarachnoid blood on CT, aneurysm on cerebral angiography, or xanthochromia in cerebrospinal fluid.
Mean headache peak pain sev…