Unruptured cerebral aneurysm producing a thunderclap headache

Witham, Timothy F.; Kaufmann, Anthony M.

doi:10.1016/s0735-6757(00)90058-5

Cited by 38 publications

(24 citation statements)

References 17 publications

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“…[10] A similar case was also reported to have symptoms as a result of acute aneurysm expansion with no associated neurological deficit who was treated with craniotomy and clip obliteration of the aneurysm. [6] In a study of patients who had chronic headaches before the diagnosis of unruptured intracranial aneurysm, 89.8% reported that their headaches recovered after the treatment of intracranial aneurysm either by surgical clipping or coil embolization. [13] This finding is in line with our case who reported marked relief of the TCH attacks after the coil embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Different retrospective series showed that 9-25% of the patients presenting with TCH were found to have cerebral aneurysms of which most of them were together with subarachnoid haemorrhage (SAH). [1,4,6] Although sudden and severe headache is the most common presentation of an acutely ruptured cerebral aneurysm, it is rarely due to an unruptured cerebral aneurysm in the absence of SAH. This may indicate a high risk of future rupture or growing of the aneurysm.…”

Section: Pain a Rimentioning

confidence: 99%

“…This may indicate a high risk of future rupture or growing of the aneurysm. [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.…”

Section: Pain a Rimentioning

confidence: 99%

“…[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%

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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: Discussionmentioning

confidence: 99%

Section: Pain a Rimentioning

confidence: 99%

Section: Pain a Rimentioning

confidence: 99%

Section: Pain a Rimentioning

confidence: 99%

See 2 more Smart Citations

Unruptured aneurysm producing thunderclap headache treated with endovascular coil embolization

Gelener

Akpınar²

2017

Agri

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“…This type of headache has been described as thunderclap headache and may be a warning of subsequent rupture. 101) The mechanism for acute headache from unruptured cerebral aneurysms is most probably local thrombosis of aneurysms or local inflammation of the meninges. 77) Headache associated with the dura of the cavernous sinus or other skull base regions often improves after surgical treatment.…”

Section: Headache and Unruptured Cerebral Aneurysmsmentioning

confidence: 99%

Symptomatic Unruptured Cerebral Aneurysms: Features and Surgical Outcome

Date

2010

Neurol. Med. Chir.(Tokyo)

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Development of less invasive imaging studies, such as magnetic resonance angiography, has increased the chances that unruptured cerebral aneurysms are found. The rupture risk of``symptomatic'' aneurysms is higher than for``asymptomatic'' aneurysms; so``symptomatic'' aneurysms are more often surgically treated. Many reviews examine``asymptomatic'' unruptured cerebral aneurysms, but few evaluate``symptomatic'' aneurysms. The author has treated many patients with symptomatic unruptured cerebral aneurysms and found that improved cranial nerve signs can be expected if the surgical treatment is performed before the symptoms become irreversible; the critical period is approximately 3 months. It is important to suppress the pulsation of the aneurysms compressing the cranial nerves; both a clipping procedure and endovascular coiling are effective. Cranial nerve signs are more commonly the symptoms of unruptured cerebral aneurysms, but large to giant aneurysms can also be the causes of hemiparesis, hydrocephalus, epilepsy, or even cerebral infarction. This review summarizes the features and surgical outcome of symptomatic unruptured cerebral aneurysms.

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Prediction of vascular abnormalities on CT angiography in patients with acute headache

Alons¹,

Goudsmit

Jellema³

et al. 2018

Brain and Behavior

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ObjectivesPatients with acute headache increasingly undergo CT‐angiography (CTA) to evaluate underlying vascular causes. The aim of this study is to determine clinical and non‐contrast CT (NCCT) criteria to select patients who might benefit from CTA.MethodsWe retrospectively included patients with acute headache who presented to the emergency department of an academic medical center and large regional teaching hospital and underwent NCCT and CTA. We identified factors that increased the probability of finding a vascular abnormality on CTA, performed multivariable regression analyses and determined discrimination with the c‐statistic.ResultsA total of 384 patients underwent NCCT and CTA due to acute headache. NCCT was abnormal in 194 patients. Among these, we found abnormalities in 116 cases of which 99 aneurysms. In the remaining 190 with normal NCCT we found abnormalities in 12 cases; four unruptured aneurysms, three cerebral venous thrombosis’, two reversible cerebral vasoconstriction syndromes, two cervical arterial dissections and one cerebellar infarction. In multivariable analysis abnormal NCCT, lowered consciousness and presentation within 6 hr of headache onset were independently associated with abnormal CTA. The c‐statistic of abnormal NCCT alone was 0.80 (95% CI: 0.75–0.80), that also including the other two variables was 0.84 (95% CI: 0.80–0.88). If NCCT was normal no other factors could help identify patients at risk for abnormalities.ConclusionsIn patients with acute headache abnormal NCCT is the strongest predictor of a vascular abnormality on CTA. If NCCT is normal no other predictors increase the probability of finding an abnormality on CTA and diagnostic yield is low.

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Unruptured cerebral aneurysm producing a thunderclap headache

Cited by 38 publications

References 17 publications

Unruptured aneurysm producing thunderclap headache treated with endovascular coil embolization

Unruptured aneurysm producing thunderclap headache treated with endovascular coil embolization

Symptomatic Unruptured Cerebral Aneurysms: Features and Surgical Outcome

Prediction of vascular abnormalities on CT angiography in patients with acute headache

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