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Neuroimaging
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
FALSE – SAHs are arterial bleeds that tend to follow the contours of the cerebral sulci. The patient classically complains of a ‘thunderclap’ headache. A CT scan is indicated acutely. Lumbar puncture can help confirm the diagnosis – look for xanthochromia.
Neurology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The initial diagnosis is often one of migraine, with which it may be confused. Two rare forms of migraine present very much like subarachnoid haemorrhage. The so-called ‘thunderclap’ headache, like subarachnoid headache, is a severe headache of sudden onset, but it is much briefer, self-limiting, not associated with a stiff neck, and not usually associated with nausea and vomiting. A similar headache can occur at orgasm and this too may present diagnostic difficulty, as berry aneurysmal subarachnoid haemorrhage may occur during sexual intercourse.
Head injuries
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Blood is present between the arachnoid mater and pia mater. Traumatic causes can occur in any age group, whilst rupture of aneurysms tends to occur in patients under 60. Patients describe a sudden, severe headache (‘thunderclap’ headache), and this can be associated with vomiting episodes and neck stiffness, which can be confused for meningitis. A non-contrast CT head is highly sensitive and blood appears most commonly in the cerebral sulci in traumatic cases.
Posterior reversible encephalopathy syndrome during convalescence from COVID-19
Published in International Journal of Neuroscience, 2023
Anaclara Michel-Chávez, Miguel García-Grimshaw, Oswaldo Alan Chávez-Martínez, Carlos Cantú-Brito, Griselda Teresa Romero-Sánchez, Fernando Daniel Flores-Silva, Francisco Javier Merayo-Chalico, Francisco Manuel Martínez-Carrillo, Ana Barrera-Vargas, Sergio Iván Valdés-Ferrer
PRES presents with non-specific neurological symptoms, such as seizures (74–87%), encephalopathy (28–94%), gradual onset diffuse headache (50%), visual disturbances (39%), and focal neurological deficits (19%). Due to overlapping pathophysiology related to endothelial dysfunction and vasoconstriction with similar clinical and neuroimaging characteristics, reversible cerebral vasoconstriction syndrome (RCVS) represents its main differential diagnosis. Moreover, PRES can co-exist in 9% of RCVS cases [6, 7]. A distinctive clinical feature of RCVS is that thunderclap headache is very common (79–100%) over 1–4 weeks in the presence of vasoconstrictive triggers [6]. According to the RCVS2 score, which has an 85% sensitivity and 100% specificity for excluding RCVS from other intracranial arteriopathies [8], this diagnosis was unlikely in our patient.
Developments in distinguishing secondary vascular headache from primary headache disorders in clinical practice
Published in Expert Review of Neurotherapeutics, 2021
Even though a first and worst ever onset headache means subarachnoid hemorrhage until proven otherwise, thus requiring investigation with CT and lumbar puncture, many admitting physicians do not feel confident in recognizing thunderclap headaches. Many patients do not provide a textbook description and many non-neurologists find it difficult to understand what a true thunderclap is. We have seen many unnecessary LP’s on one hand and dismissal of a relatively good description on the other. We find the two questions of immense help; if the pain felt like a hit from a baseball or cricket bat and if the headache reached its peak in 5 min. We rarely see sub-hyloid hemorrhage and many patients don’t have the typical Kernig’s or Brudzinsky’s sign. Although sub-arachnoid hemorrhage is the most common cause of secondary thunderclap headache, many other vascular headaches for example, pituitary apoplexy, carotid dissection and cerebral venous thrombosis could present this way.
Granulomatosis with polyangiitis masquerading as pituitary adenoma with apoplexy
Published in Modern Rheumatology Case Reports, 2021
Keenan Piper, Stephanie R. Beldick, Michael Karsy, Tanya Allawh, Monika Shirodkar, Jeffrey Miller, Marianthi Kiriakidou, Mark Curtis, James J. Evans
The patient is a 41-year-old previously healthy female who presented with a new onset thunderclap headache. Brain imaging revealed a sellar and suprasellar lesion with intense rim enhancement and a central complex cystic component (Figure 1). The patient underwent left-sided unilateral transsphenoidal, microsurgical resection of a presumed pituitary adenoma with apoplexy at an outside hospital. Pathology of the resection specimen led to an initial diagnosis of a prolactin and growth hormone expressing pituitary adenoma with inflammation. Following surgery, the patient was treated with intravenous dexamethasone and underwent evaluation for panhypopituitarism. Hydrocortisone administration was initiated for secondary adrenal insufficiency, desmopressin for central diabetes insipidus and levothyroxine for borderline hypothyroidism. Once the patient’s symptoms, endocrine labs and neurological exam had improved, she was discharged from the hospital on these medications.