Hypertensive Encephalopathy Presenting With Thunderclap Headache

Abstract

A 68-year-old woman presented with thunderclap headache, which led to a search for subarachnoid hemorrhage. Both computerized tomography of the head and cerebrospinal fluid examination were normal. Magnetic resonance imaging revealed abnormalities in the white matter in the parieto-occipital regions. There was no aneurysm on magnetic resonance angiography. Treatment of hypertension led to resolution of the posterior leukoencephalopathy. Hypertensive encephalopathy with reversible posterior leukoencephalopathy can present as a thunderclap headache.

Reversible cerebral vasoconstriction syndrome: an under-recognized clinical emergency

“…Heightened sympathetic activities are plausible with observations of SBP and triggers with elevated sympathetic tone in a great proportion of spontaneous RCVS patients [Ducros et al 2007;Chen et al 2006a]. In addition, evidence from secondary RCVS, such as patients with pheochromocytoma [Heo et al 2009;Im and Kim, 2008;Armstrong and Hayes, 1961], acute hypertensive crises [Tang-Wai et al 2001], or ingestion of sympathomimetic drugs [Kaye and Fainstat, 1987;Margolis and Newton, 1971], also support the significance of excessive sympathetic activity or an abnormal vascular response to circulating catecholamines. However, since the vasoconstrictions persist for a protracted course beyond headache resolution , there should be some factors regulating vascular tone other than heightened sympathetic activity participating in the pathogenesis.…”

Reversible cerebral vasoconstriction syndrome: current and future perspectives

“…Aberrant sympathetic response of cerebral vasculature is a preferred hypothesis [37]. Blood pressure surge [12,15], triggers with elevated sympathetic tone [12,15], ingestion of sympathomimetic vasoactive substances [10,14,15,17], pheochromocytoma [40][41][42] and acute hypertensive crises [43] all support the role of sympathetic overactivity. In addition, it is hypothesized that some of the immunologic and biochemical factors known to regulate vascular tone in the delayed vasospasm in SAH might also be important in the pathophysio logy of vasoconstriction in RCVS [44][45][46], although direct evidences are lacking.…”

Acute migraine in the Emergency Department: extending European principles of management

“…Headache can be a signal for rare disorders such as pituitary apoplexy, colloidal cyst of the third ventricle, giant cell arteritis, carotid or vertebral artery dissection, acute hypertensive crisis or acute myocardial infarction [35][36][37][38][39][40].…”