Cerebral infarct presenting with thunderclap headache

Abstract

A 73-year-old man presented with a thunderclap headache (TCH), suggesting a subarachnoid haemorrhage. Neurological examination, computer tomography of the head, and cerebrospinal fluid examination were normal. Magnetic resonance imaging of the brain revealed a supratentorial cerebral infarct. No cerebral aneurysm could be detected. A TCH can be the presenting feature of many conditions. A formula for the diagnostic assessment of TCH should be established. The management of this type of headache is controversial. Articles differ in their conclusions and recommendations. An expansion of routine investigations should be performed in cases where the neurological examination, cerebrospinal fluid analysis, and computer tomography are normal. A TCH can be the primary clinical feature of a supratentorial cerebral infarct.

A case of cerebellar infarction presenting as thunderclap headache

“…An ADC map shows low ADC values in the corresponding location (f, arrow) over subsequent weeks or months (headache may recur within the first week after onset), no evidence of another disorder (in particular, normal CSF and normal brain imaging are required) [3]. A number of other disorders present with a TCH include subarachnoid hemorrhage, cerebral venous sinus thrombosis, pituitary apoplexy, spontaneous intracranial hypotension, hypertensive encephalopathy, and retroclival hematoma [4]. On the other hand, TCH is a rare manifestation of a cerebral or cerebellar infarction.…”

“…This response results in increased nociceptive input into the nervous system and leads to headache. Vasoactive and spasmogenic substances, such as endothelin-1 and 3, norepinephrine, prostaglandin E2, thromboxane A2, leukotriene C4, and neuropeptide Y, may play important roles in the mechanisms of primary and secondary TCHs, including reversible cerebral vasoconstriction [4,6,[11][12][13].…”

Ischemic Stroke Presenting as Thunderclap Headache: Report of Two Cases and Review of the Literature

“…We were able to find 9 other cases of IS and TCH in the literature [1][2][3][4][5] . Five of them were reported in a large series of TCH [5] , but we did not include them in the comparative table since the characteristics of the patients were not described in detail nor was it specified whether TCH was the main feature of the stroke.…”

“…Different from the secondary form, primary TCH has a benign prognosis and is a diagnosis of exclusion. IS is not considered to be a typical cause of secondary TCH, and there are only a few reports of IS patients presenting with this type of headache, especially when the pain is the main clinical feature [1][2][3][4] .…”

“…It was spontaneously deDear Sir, Headache is commonly reported in acute ischemic stroke (IS) onset, occurring in about one-fourth of patients. However, a sudden and severe headache, with characteristics of thunderclap headache (TCH) as the main manifestation of an IS, is extremely rare and only a few cases have been described [1][2][3][4][5] . We report 2 cases of IS presenting with TCH as the primary clinical feature.…”