A healthy 44-year-old marathon runner collapses mid-stride with what she describes as an explosive, instantaneous headache unlike anything she has ever experienced. As her neck stiffens and her level of consciousness flickers in the emergency bay, the clinical team faces a frantic, protocol-driven race against the clock where an initial diagnostic test may carry a treacherous false-negative risk. This high-yield case dissects the critical anatomy of circle of Willis aneurysms, the exact sequence of neuroimaging versus lumbar puncture, and the lethal complications tested on every medical licensing exam.

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