Thunderclap Headache With Normal CT and Lumbar Puncture

Savitz, Sean I; Edlow, Jonathan A.

doi:10.1161/strokeaha.107.503151

Cited by 18 publications

(14 citation statements)

References 12 publications

(5 reference statements)

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“…[1,4,6] Also some retrospective surveys of patients with subarachnoid haemorrhage suggest that minor episodes with sudden headache (warning leaks) may precede rupture of an aneurysm, and that early recognition and treatment might lead to improved outcome. [7] In different studies the mechanisms underlying TCH due to unruptured aneurysms were diffuse, multifocal and segmental cerebral vasospasm in the absence of haemorrhage, morphologic changes like stretching, expansion, dissection, [8] local thrombosis in the wall [9] and limited leakage of blood which implies that partial rupture has occurred in to the subarachnoid space. [6,10] …”

Section: Pain a Rimentioning

confidence: 99%

Unruptured aneurysm producing thunderclap headache treated with endovascular coil embolization

Gelener

Akpınar²

2017

Agri

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ÖzetHastaların yaşamlarındaki en şiddetli başağrısı olarak tarifledikleri, ani olarak gelişen başağrısı oldukça dikkat edilmesi gereken bir durumdur. 32 yaşındaki kadın hasta, son bir haftadır sıklığı ve şiddeti gittikçe artan gökgürültüsü başağrısı atakları nedeniyle başvurdu. Son bir haftada birkaç kez acil başvurduğunu ve çekilen beyin tomografisinin normal olarak raporlandığını ifade etti. Son başvurusunda nörolojik muayenesinde, sol komplet okülomotor sinir felci saptandı. Beyin manyetik rezonans görüntüleme ve anjiografisinde solda posterior komunikan arter anevrizmasının ipsilateral okülomotor sinire bası yaptığı gö-rüldü. Subaraknoid hemoraji izlenmedi. Anevrizma tedavisine yönelik endovasküler balon aracılı koil embolizasyonu yapıldı. Girişimsel işlemden hemen sonra başağrıları düzeldi. Tedavinin üçüncü ayında ise komplet ptoz düzeldi. Gökgürültüsü başağ-rısı, kanamamış anevrizmalarda çok sık beklenen bir durum değildir ancak gelişmekte olan bir rüptürün habercisi olabilir, bu sebeple erken tanı ve tedavi oldukça önemlidir.Anahtar sözcükler: Koil embolizasyonu; gökgürültüsü başağrısı; kanamamış anevrizma SummaryThe abrupt onset of acute high intensity headache, unlike any experienced before, can be a urgent medical condition in which attention should be given. A 32 year old female patient who developed thunderclap headache attacks had applied with increasing intensity and frequency since one week. She had been to the emergency department several times and the cranial computed tomography was reported normal. On the last application, the neurologic examination showed complete oculomotor nerve palsy on the left. Brain magnetic resonance imaging together with intracranial brain angiography revealed left posterior communicating aneurysm compressing ipsilateral oculomotor nerve with no evidence of subarachnoid hemorrhage. The patient was treated by endovascular balloon assisted coil embolization of the aneurysm under digital subtraction angiography. As a result, the headache resolved soon after the intervention. Also complete ptosis recovered on the third month. Although thunderclap headache had rarely been ascribed to an enlarging unruptured cerebral aneurysm, early recognition and treatment is rather important as it may indicate a high risk of rupture.

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Section: Pain a Rimentioning

confidence: 99%

Unruptured aneurysm producing thunderclap headache treated with endovascular coil embolization

Gelener

Akpınar²

2017

Agri

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“…If the CT will be negative for expansive process and intracranial hypertension signs it is necessary made a lumbar puncture. 47 If the cerebrospinal fluid (CSF) has blood spots, it should be immediately centrifuged. A yellow color supernate, known as xantocromia, is suggesting a subarachnoid hemorrhage.…”

Section: Thunderclap Headachementioning

confidence: 99%

“…High CSF pressure could suggest cerebral venous thrombosis or intracranial hypertension while a low CSF pressure could specify intracranial hypotension. 47 Negative CT does not keep out the subarachnoid hemorrhage. CT is negative for 2% of cases in the first 12 h from the onset; in addition it is negative for 10% of cases in the first 24 h and for 50% of cases in the next 5 days.…”

Section: Thunderclap Headachementioning

confidence: 99%

The management of the patient with headache: from evidence to clinical practice

Gnerre¹,

Para

Antoniis

et al. 2015

Ital J Med

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EpidemiologyHeadaches are the most prevalent neurological disorders and are among the most frequent symptoms seen in general practice. The headache is about 30% of neurological specialist visits and continues to be a frequent cause of ED use, accounting for 2% of all visits. 4 50% of the general population have headaches during any given year, and more than 90% of them report a lifetime history of headache. 5 The only Italian epidemiological study (PACE study) 6 showed that 52% of men a and 43% of women interviewed suffered from headache in the last year. 7 Primary headache Migraine IntroductionMigraine is a common, debilitating headache disor- ABSTRACTHeadaches are the most prevalent neurological disorders and continue to be a frequent cause of Emergency Department use, accounting for 2% of all visits. Although it is a neurological disease it must be also a clinical competence of internist for its nature and frequency. The keys to effective management of these syndromes are differential diagnosis through history, physical examination, and diagnostic studies when necessary. This monograph highlights the importance of establishing whether headache is a secondary symptom of another disease process or a primary condition. The goal of headache management is for patients and healthcare professionals to work together to minimize pain and improve quality of life.

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“…1 The differential diagnosis includes but is not limited to subarachnoid hemorrhage (SAH), cerebral venous sinus thrombosis, cervical artery dissection, and pituitary apoplexy. [2][3][4] Current clinical practice and major print and online emergency medicine textbooks suggest that a negative computed tomographic (CT) head scan combined with a negative lumbar puncture (LP) result are adequate to rule out SAH in patients with acute headache presenting to the emergency department (ED). [5][6][7][8] Several studies support this practice; however, all of these studies suffered from a small sample size (71, 14, 18, 137, and 93 patients, respectively; N 5 333).…”

Section: Introductionmentioning

confidence: 99%