An 8 year old girl is brought to the ED from school. She is accompanied by her teacher who gives the history.

She was sat in class when she complained of tingling on the left hand side of her body. The teacher noted that she had slurred speech during this episode. Following this she developed a severe headache and became very agitated and vomited.

An ambulance was called and she was brought to the ED.

On arrival she was difficult to assess as clearly distressed by the circumstances and by the environment. She was apparently photophobic. There was no rash, no neck stiffness and no other features of meningism. The parents are not contactable but to the teachers knowledge she is previosuly fit and well and not on any regualr medication.

Following your initial assessment she becomes increasingly distressed due to the severity of the headache and appears to be unable to get comfortable in the bed.