Intracranial vessel wall MR imaging of an intradural vertebral artery dissection

Atsina, Kofi-Buaku; Rothstein, Aaron; Messé, Steven R.; Song, Jae Woo

doi:10.1016/j.clinimag.2020.06.024

Cited by 8 publications

(1 citation statement)

References 12 publications

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“…The sensitivity and specificity of MRA and CTA for detection of cervicocephalic arterial dissection are similar but vary significantly across studies, from 50 to 100% for sensitivity and 29 to 100% for specificity [44], and catheter angiography is the gold standard. In recent years, vessel wall MRI has provided higher resolution of the intimal flap, double lumen and intramural hematoma, improving diagnostic confidence [45 ▪ ,46–48]. Some serum markers may aid in the diagnosis, such as the neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio [49] and matrix metalloproteinase 9 level [50].…”

Section: Evaluation Specific To Different Etiologiesmentioning

confidence: 99%

Evaluating thunderclap headache

Chen

Fuh

2021

Current Opinion in Neurology

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Purpose of review Thunderclap headache (TCH) is an abrupt-onset of severe headache that needs to be thoroughly investigated because the most common secondary cause is subarachnoid hemorrhage (SAH). There has been no consensus guideline regarding the diagnostic workup. This review aims to provide an update on the evaluation of TCH. Recent findings The most important update in the 2019 American College of Emergency Physicians guideline for evaluation of acute headache in the emergency department is that negative noncontrast brain computed tomography (CT) findings within 6 h from ictus essentially excludes SAH. Additionally, the updated guideline recommends that after a negative brain CT, CT angiogram is a reasonable alternative to lumbar puncture if clinical suspicion of an intracranial source of SAH is high. An important update of reversible vasoconstriction syndrome (RCVS), the second most common etiology of TCH, is the RCVS2 score development based on clinical and radiological features, providing high specificity and sensitivity for distinguishing RCVS from other intracranial arteriopathies. Summary Although the evaluation of TCH is exhaustive, the potentially catastrophic consequence of a missed diagnosis of sentinel headache justifies the efforts. Awareness of the clinical features and application of diagnostic tools specific for different pathological conditions can facilitate the diagnostic workup.

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