Answer :
Final Answer:
The next step in the management of an elderly patient with intense retro-orbital headache, neck pain, and high blood pressure (hypertension) persisting for hours despite an unremarkable non-contrast CT scan would be to perform a lumbar puncture to evaluate for subarachnoid hemorrhage.
Explanation:
The combination of intense retro-orbital headache, neck pain, and high blood pressure in an elderly patient raises concerns for a potential subarachnoid hemorrhage (SAH), especially if symptoms persist despite an unremarkable non-contrast CT scan. SAH is a medical emergency characterized by bleeding into the subarachnoid space, often resulting from a ruptured intracranial aneurysm. While non-contrast CT scans are often the initial imaging modality to assess for acute intracranial pathology, they may not always detect small hemorrhages, especially in the early stages. Therefore, a lumbar puncture is indicated to assess for the presence of blood in the cerebrospinal fluid, which can confirm or rule out the diagnosis of SAH.
