LAUSR

A developmentally normal and previously well 15yearold boy, presented to hospital with a 4hour history of gradually worsening, throbbing, leftsided 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 rightsided 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 selfresolving 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. Susceptibilityweighted imaging (SWI) sequences demonstrated vascular asymmetry (figure 1). The patient had been started on antiviral and antibiotic treatment for possible meningoencephalitis. Within the next 24 hours, he was extubated, and his neurological symptoms fully resolved. He still had some vomiting and a mild headache. Baseline bloods, blood culture and cerebrospinal fluid microscopy and culture were normal. A repeat MRI (figure 1) of the brain 2 months later showed symmetrical vascular filling bilaterally. At followup, his neurological examination remained normal.