Long-Term Follow-Up of 71 Patients With Thunderclap Headache Mimicking Subarachnoid Haemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

“…211 A normal CT scan and CSF examination exclude a warning leak in most cases and predict a more favorable prognosis in the setting of severe and/or sudden headache. 212,213 It has been recommended that patients with a normal CT scan and CSF examination be offered reassurance, symptomatic headache treatment, and appropriate consultative referral as indicated. 195 Use of MRI in the diagnosis of SAH has evolved.…”

Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association.

“…A normal CT scan and spinal fluid examination in most cases exclude a warning leak and predict a favorable prognosis in the setting of severe and/or sudden headache. 64 - 65 The usefulness of magnetic resonance imaging (MRI) in the diagnosis of SAH is controversial. Adequate blinded studies comparing MRI with CT scanning have not been performed, 6 *- 68 and concerns remain about the relative insensitivity of MRI for detecting subarachnoid blood in the acute stage after SAH.…”

What Are the Unintended Consequences of Changing the Diagnostic Paradigm for Subarachnoid Hemorrhage After Brain Computed Tomography to Computed Tomographic Angiography in Place of Lumbar Puncture?

“…3,[19][20][21] Information from these case reports must be balanced against the numerous articles reporting consecutive series of patients. [22][23][24][25][26][27][28] In the case series, asymptomatic aneurysms averaged 11 mm in size, whereas the symptomatic ones averaged 21 mm, providing indirect evidence that many of the smaller aneurysms found on CTA are not causing symptoms. 19 A pooled analysis (of the above seven studies) analyzed 814 patients with thunderclap headache, normal CT, and normal CSF.…”