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Thunderclap headache in a patient with Salmonella Enterica meningitis
1Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract:
We report on a case of Salmonella enterica meningitis in a healthy, immunocompetent adult who presented with a thunderclap headache. This case illustrates the importance of avoiding early diagnostic closure, particularly when initial results are unrevealing. Although Salmonella enterica meningitis is exceedingly rare, this patient's persistent symptoms of nausea,vomiting and ongoing, without a history of migraine prompted further evaluation despite a negative non-contrast head CT for subarachnoid hemorrhage. A subsequent lumbar puncture ultimately confirmed the diagnosis. This case highlights the need for emergency physicians to maintain a broad differential diagnosis and continue diagnostic workups when clinical suspicion remains high, even in the absence of classic signs of life- threatening conditions like meningitis.
Insights
Salmonella enterica meningitis is rare in healthy adults but can cause severe headaches. Persistent symptoms warrant further investigation beyond initial negative tests to ensure accurate diagnosis.
Area of Science:
- Neurology
- Infectious Diseases
- Internal Medicine
Background:
- Salmonella enterica meningitis is an uncommon but serious infection.
- Adult meningitis cases often present with non-specific symptoms.
- Prompt diagnosis is crucial for effective treatment and patient outcomes.
Observation:
- A healthy, immunocompetent adult presented with a sudden, severe thunderclap headache.
- Initial non-contrast head CT was negative for subarachnoid hemorrhage.
- Persistent nausea, vomiting, and headache prompted further diagnostic evaluation.
Findings:
- Lumbar puncture confirmed Salmonella enterica meningitis.
- The case highlights the challenge of diagnosing rare infections with atypical presentations.
- Early diagnostic closure was avoided due to persistent clinical suspicion.
Implications:
- Emergency physicians must maintain a broad differential diagnosis for severe headaches.
- Continued diagnostic workup is essential when clinical suspicion for meningitis remains high.
- This case underscores the importance of considering rare pathogens in unexplained neurological symptoms.
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