Approach to Thunderclap Headache Flashcards
3 types of imaging used to investigate thunderclap headache
NCCT
CTA
Lumbar puncture
What is a thunderclap headache
Severe headache of sudden onset
Instantaneous peak to maximum severity
“Worst headache of my life”
Causes of SAH
Intracranial aneurysms
Other spontaneous causes
Trauma
Other symptoms of SAH
Impaired LOC
Neck stiffness
Nausea/vomiting
Occipital headache
Terson’s hemorrhage
Any intraocular hemorrhage associated with intracranial hemorrhage and increased intracranial pressure
Reversible cerebral vasospasm (RCVS)
Non inflammatory transient vasculopathy characterized by recurrent thunderclap headache and segmental multifocal vasoconstriction
Recurrent thunderclap headaches
Interictal lower-level headache is common
Headache frequency does not reliably correlate with progression of vasoconstriction
Risk factors for RCVS
Meds (SSRIs, decongestants) Recreational drugs (marijuana, cocaine) Eclampsia Hypertensive encephalopathy Trauma Head and neck surgery
Treatment for RCVS
Hydration
Calcium channel blockers
Dissection
Separation of arterial wall layers
Can be spontaneous or traumatic
Commonly presents with neck pain, headache
Most commonly in the C1 loop
Treatment for a dissection
Antiplatelet or anticoagulation
Posterior Reversible Leukoencephalopathy (PRES)
Headaches, altered LOC, visual disturbances, seizures
Mechanisms heterogenous (associated with endothelial dysfunction, BBB disruption, parenchymal involvement)
Vasogenic edema
Treatment for PRES
Lower BP
Remove offending agent
Use of MgSO4 in post partum/eclampsia context
Cerebral venous thrombosis
Headaches, seizures, focal neurological deficits
Treatmetn: anticoag, supportive care of seizures, increased ICP, pain control
Colloid cyst
Benign growth
Usually attached to 3rd ventricle
Can cause obstruction of CSF leading to acute hydrocephalus, and sudden LOC/death
Spontaneous CSF leak
Can also be iatrogenic or post traumatic
Postural headache (worse when sitting up, worse w valsalva)
Because of a lack of pressure
Can develop focal neurologic deficits (generally reversible)
