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A developmentally normal and previously well 15-year-old boy, presented to hospital with a 4-hour history of gradually worsening, throbbing, left-sided headache spreading across his whole head. Four hours prior, he could not read properly or string words together and felt tired. He developed a headache followed by expressive aphasia, agitation and vomiting. A right-sided lower facial droop was noted that resolved in a couple of hours. He played a rugby match in the morning and there was a history of minor head injury without loss of consciousness.
He started to develop self-resolving apnoeic episodes each lasting for 30–60 seconds. He initially had a CT of the brain followed by emergency MRI/MRA (magnetic resonance angiography) of the brain after being intubated and ventilated. All scans were reported as normal. Susceptibility-weighted imaging (SWI) sequences demonstrated vascular asymmetry (figure 1).
DH and JH are joint first authors.
Presented at Case also presented as a poster at the joint European Stroke Organisation and World Stroke Organisation Conference May 2020. Also presented as a poster in BPNA 2022.
Contributors DH and JH are joint first authors as they conceptualised and designed the report, acquired patient data, drafted the initial manuscript, critically reviewed the manuscript and approved the final manuscript as submitted. CM and NL reviewed the patient themselves and helped acquire patient data. FK reported all the scan imaging. TK supervised the case and revised and approved the final manuscript as submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.