1. Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 14 year old male with headache and neck stiffness

2. Vignette A 14 year old right-handed male presented to our hospital with sudden onset of severe headache and neck stiffness. Physical exam showed arm asymmetry with smaller size and muscle bulk (present since childhood), and increased deep tendon reflexes on the right, but normal strength. LP and head CT ruled out intracranial bleed or infection. Moeck et al.

3. Imaging Moeck et al.

4. A Pediatric Patient with Headache and Neck Stiffness Unruptured type III spinal arteriovenous malformation at the C3-C4 level supplied by right vertebral artery. 1 Subtle findings on physical exam can indicate severe underlying pathology and should not be overlooked in the proper context. Vascular studies should be considered for severe headache with negative initial workup. Moeck et al.