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Tom Hayton - One of the best experts on this subject based on the ideXlab platform.
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po027 spontaneous cervical epidural haematoma presenting as Thunderclap Headache case presentation
Journal of Neurology Neurosurgery and Psychiatry, 2017Co-Authors: Barbara Wysota, A C Williams, Tom HaytonAbstract:Thunderclap Headache is most commonly associated with subarachnoid haemorrhage or other acute intracranial pathology. It’s typically investigated with head imaging and lumbar puncture. We are presenting here the case of spontaneous cervical epidural haematoma manifesting as Thunderclap Headache. This pathology could be missed by following standard investigations of Thunderclap Headache and highlighting importance of through clinical history. 86 year old man presented to Emergency Department with Thunderclap Headache and loss of consciousness. Patient developed severe occipital Headache while leaving the bath than lost consciousness. After waking up he was unable to stand up, his lower legs felt numb and weak. Headache gradually improved within 30 min. His CT head after arrival to A and E didn’t show any acute intracranial pathology. CSF was normal, xantochromia was negative. Within 48 hours patient recovered almost completely. Was able to mobilise independently and was considered fit for discharge by medical team. After neurology review MRI scan of cervical spine was organised revealing spontaneous cervical epidural haematoma.
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PO027 Spontaneous cervical epidural haematoma presenting as Thunderclap Headache – case presentation
Journal of Neurology Neurosurgery and Psychiatry, 2017Co-Authors: Barbara Wysota, A C Williams, Tom HaytonAbstract:Thunderclap Headache is most commonly associated with subarachnoid haemorrhage or other acute intracranial pathology. It’s typically investigated with head imaging and lumbar puncture. We are presenting here the case of spontaneous cervical epidural haematoma manifesting as Thunderclap Headache. This pathology could be missed by following standard investigations of Thunderclap Headache and highlighting importance of through clinical history. 86 year old man presented to Emergency Department with Thunderclap Headache and loss of consciousness. Patient developed severe occipital Headache while leaving the bath than lost consciousness. After waking up he was unable to stand up, his lower legs felt numb and weak. Headache gradually improved within 30 min. His CT head after arrival to A and E didn’t show any acute intracranial pathology. CSF was normal, xantochromia was negative. Within 48 hours patient recovered almost completely. Was able to mobilise independently and was considered fit for discharge by medical team. After neurology review MRI scan of cervical spine was organised revealing spontaneous cervical epidural haematoma.
Shuujiun Wang - One of the best experts on this subject based on the ideXlab platform.
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bath related Thunderclap Headache a study of 21 consecutive patients
Cephalalgia, 2008Co-Authors: Shuujiun Wang, Jiingfeng Lirng, Zinan Wu, Shihpin ChenAbstract:We consecutively recruited 21 patients (all women, mean 54 ± 8 years) with bath-related Thunderclap Headache (BRTH). Thirteen of them were in menopause, two had just ceased hormonal therapy, and one was at 3 months postpartum. Bathing was the initial trigger for Thunderclap Headaches in nine patients (43%). Many patients (n = 15, 71%) had other non-bath-related attacks. Most patients (n = 18, 86%) reported that the Headache occurred immediately when water was sprayed over their body, with warm water (52%) as the most common. During the disease course [mean 14 days (6–34)], the mean number of BRTH was 5.1 ± 3.6 attacks. Nineteen patients (90%) changed bathing habits to prevent attacks. Thirteen patients (62%) had magnetic resonance angiography vasoconstrictions, and two of them (15%) developed reversible posterior encephalopathy. None of the patients without vasoconstrictions had this complication. Nimodipine was effective in stopping further attacks in 84% (16/19) treated patients. No relapse was reported at a mean follow-up of 30 months. BRTH occurred exclusively in women and predominantly in middle age. Deficiency or fluctuation of female sex hormones may play a role. About 60% patients showed cerebral vasospasms, fulfilling the diagnosis of reversible cerebral vasoconstriction syndrome and indicating a risk of posterior encephalopathy.
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Bath‐related Thunderclap Headache: a study of 21 consecutive patients
Cephalalgia, 2008Co-Authors: Shuujiun Wang, Zinan Wu, Shihpin Chen, Jiingfeng LirngAbstract:We consecutively recruited 21 patients (all women, mean 54 ± 8 years) with bath-related Thunderclap Headache (BRTH). Thirteen of them were in menopause, two had just ceased hormonal therapy, and one was at 3 months postpartum. Bathing was the initial trigger for Thunderclap Headaches in nine patients (43%). Many patients (n = 15, 71%) had other non-bath-related attacks. Most patients (n = 18, 86%) reported that the Headache occurred immediately when water was sprayed over their body, with warm water (52%) as the most common. During the disease course [mean 14 days (6–34)], the mean number of BRTH was 5.1 ± 3.6 attacks. Nineteen patients (90%) changed bathing habits to prevent attacks. Thirteen patients (62%) had magnetic resonance angiography vasoconstrictions, and two of them (15%) developed reversible posterior encephalopathy. None of the patients without vasoconstrictions had this complication. Nimodipine was effective in stopping further attacks in 84% (16/19) treated patients. No relapse was reported at a mean follow-up of 30 months. BRTH occurred exclusively in women and predominantly in middle age. Deficiency or fluctuation of female sex hormones may play a role. About 60% patients showed cerebral vasospasms, fulfilling the diagnosis of reversible cerebral vasoconstriction syndrome and indicating a risk of posterior encephalopathy.
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recurrent primary Thunderclap Headache and benign cns angiopathy spectra of the same disorder
Neurology, 2006Co-Authors: Shihpin Chen, Jiingfeng Lirng, Fengchi Chang, Shuujiun WangAbstract:Objectives: To investigate the clinical pictures of patients with recurrent Thunderclap Headaches of unknown etiology and to field-test two relevant International Classification of Headache Disorders , 2nd edition (ICHD-II) criteria, i.e., primary Thunderclap Headache (Code 4.6) and benign (or reversible) angiopathy of the CNS (Code 6.7.3). Methods: We prospectively recruited patients presenting with idiopathic recurrent Thunderclap Headaches from a hospital-based Headache clinic. Detailed histories, neurologic examinations, and MRIs and magnetic resonance angiographies (MRAs) were performed in all patients to exclude secondary causes. Patients with cerebral vasoconstriction received serial MRA follow-up. Results: Fifty-six consecutive patients (51 female/5 male, mean age 49.6 ± 9.8 [range 22 to 76] years) were enrolled. Segmental vasoconstriction (or benign CNS angiopathy) was found in 22 patients (39%). Thunderclap Headache recurred in all patients with a median frequency of 0.7 times per day for a median period of 14 days (range 6 to 86 days). The median duration for each single attack was 3 hours. Most patients (84%) reported at least one trigger. Nimodipine effectively aborted further attacks in 83% of the treated patients. Headache attacks subsided within 3 months. Four patients (7%) developed ischemic complications. Patients with and without vasoconstriction based on MRA images were similar regarding demographics and Headache profile. Except for the duration criterion, our patients generally mapped well into the proposed ICHD-II criteria. Conclusions: This study suggests that the two diagnostic entities proposed by the ICHD-II may present different spectra of the same disorder. The distinct Headache profile may help physicians quickly recognize this disabling Headache disorder with risk of stroke and provide timely treatment.
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nimodipine for treatment of primary Thunderclap Headache
Neurology, 2004Co-Authors: Shiangru Lu, Yichu Liao, Jiingfeng Lirng, Shuujiun WangAbstract:Eleven patients with primary Thunderclap Headache (TCH) were treated with oral nimodipine 30 to 60 mg every 4 hours or IV nimodipine 0.5 to 2 mg/h if the oral regimen failed or images showed cerebral vasospasm. With oral nimodipine, Headache did not recur in the nine patients without vasospasm. IV nimodipine was given in two patients with vasospasm, including one who developed ischemic stroke. Nimodipine may be effective for TCH. Vasospasm may warrant IV nimodipine.
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bathing Headache a variant of idiopathic Thunderclap Headache
Cephalalgia, 2003Co-Authors: Yichu Liao, Shiangru Lu, Jiingfeng Lirng, Zinan Wu, Shuujiun WangAbstract:Bathing Headache is rarely described in literature. We report four middle-aged Taiwanese women who developed severe throbbing Headache with maximum intensity of onset during bathing. Diffuse cerebral vasospasm was demonstrated in one of them. All their Headaches resolved spontaneously (n = 1) or after nimodipine treatment (n = 3). Except for one patient with vasospasm in whom reversible posterior leukoencephalopathy and an asymptomatic cerebellar infarction developed, the others recovered without any complications. The clinical profile of bathing Headache points to idiopathic Thunderclap Headache. It may not be as benign as previously reported. Nimodipine might be effective in treatment of this special Headache syndrome.
David William Dodick - One of the best experts on this subject based on the ideXlab platform.
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Thunderclap Headache: An approach to a neurologic emergency
CURR NEUROL NEUROSCI, 2007Co-Authors: David William DodickAbstract:Thunderclap Headache (TCH) refers to an excruciating Headache of instantaneous onset. Recognition and accurate diagnosis of this Headache are important because it can be caused by various serious underlying brain disorders such as subarachnoid hemorrhage, intracranial hematoma, cerebral venous sinus thrombosis, cervical artery dissection, ischemic stroke, pituitary apoplexy, acute arterial hypertension, spontaneous intracranial hypotension, third ventricle colloid cyst, and intracranial infections. Patients with TCH who have evidence of reversible, segmental, cerebral vasoconstriction of circle of Willis arteries and normal or near-normal cerebrospinal fluid evaluation are considered to have reversible cerebral vasoconstriction syndrome. Primary TCH is diagnosed when no underlying etiology is identified. In this review, we discuss the differential diagnosis of TCH, outline the characteristics and diagnostic criteria for primary TCH, offer a pathophysiologic hypothesis for primary TCH, and detail the diagnostic evaluation of the patient presenting with TCH.
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Thunderclap stroke embolic cerebellar infarcts presenting as Thunderclap Headache
Headache, 2006Co-Authors: Todd J Schwedt, David William DodickAbstract:Thunderclap Headache is known to be a presenting feature of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous thrombosis, cervical artery dissection, spontaneous intracranial hypotension, pituitary apoplexy, retroclival hematoma, and hypertensive reversible posterior leukoencephalopathy. We describe a case of Thunderclap Headache in the absence of focal, long-tract, or lateralizing neurological findings, as the primary clinical feature of embolic cerebellar infarcts. This case expands the differential diagnosis of Thunderclap Headache and reinforces the need for magnetic resonance imaging in the evaluation of such patients, even when neurologic examination, brain computed tomography, and cerebrospinal fluid analysis are normal.
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Thunderclap Headache
LANCET NEUROL, 2006Co-Authors: David William DodickAbstract:Thunderclap Headache (TCH) is head pain that begins suddenly and is severe at onset. TCH might be the first sign of subarachnoid haemorrhage, unruptured intracranial aneurysm, cerebral venous sinus thrombosis, cervical artery dissection, acute hypertensive crisis, spontaneous intracranial hypotension, ischaemic stroke, retroclival haematoma, pituitary apoplexy, third ventricle colloid cyst, and intracranial infection. Primary Thunderclap Headache is diagnosed when no underlying cause is discovered. Patients with TCH who have evidence of reversible, segmental, cerebral vasoconstriction of circle of Willis arteries and normal or near-normal results on cerebrospinal fluid assessment are thought to have reversible cerebral vasoconstriction syndrome. Herein, we discuss the differential diagnosis of TCH, diagnostic criteria for the primary disorder, and proper assessment of patients. We also offer pathophysiological considerations for primary TCH.
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nonaneurysmal Thunderclap Headache with diffuse multifocal segmental and reversible vasospasm
Cephalalgia, 1999Co-Authors: David William Dodick, Robert D Brown, J W Britton, J HustonAbstract:Objective. To highlight the clinical profiles and angiographic findings of two patients with recurrent Thunderclap Headache (TCH) without subarachnoid hemorrhage (SAH) and to present modified diagnostic criteria for this unusual syndrome.Background. TCH may be a benign recurrent Headache disorder or it may represent a serious underlying process such as SAH or venous sinus thrombosis. The pathophysiology of this disorder in the absence of underlying pathology is not well understood and its potential angiographic features are not well appreciated.Methods. Two case descriptions with illustrative angiography.Results. Both cases demonstrated the potential for reversible intracranial vasospasm without intracranial aneurysm or SAH and a benign clinical outcome.Conclusions. Primary TCH has a distinctive clinical and angiographic profile and must be distinguished from central nervous system vasculitis and SAH.
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pituitary apoplexy presenting as a Thunderclap Headache
Neurology, 1998Co-Authors: David William Dodick, Eelco F M WijdicksAbstract:Pituitary apoplexy is an uncommon clinical syndrome characterized by acute Headache, ophthalmoplegia, diminished visual acuity, and altered mental status caused by the sudden hemorrhage or infarction of a pituitary gland that invariably harbors an adenoma. This case highlights the variability in presentation and underscores the need for a high index of suspicion and the need for MRI in patients presenting with Thunderclap Headache and "normal" initial investigations. Case report. While eating dinner, this 50-year-old woman was thunderstruck by an intense Headache, nausea, and recurrent vomiting. She visited a local emergency ward on the second and fifth day of her illness. Injections of meperidine and ketorolac were given, but no investigations were done and no diagnosis was rendered. The patient's family physician saw her on the third day of her illness and obtained a CT of the brain, which was interpreted as normal. She developed ptosis of the right lid and diplopia 4 days …
Barbara Wysota - One of the best experts on this subject based on the ideXlab platform.
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po027 spontaneous cervical epidural haematoma presenting as Thunderclap Headache case presentation
Journal of Neurology Neurosurgery and Psychiatry, 2017Co-Authors: Barbara Wysota, A C Williams, Tom HaytonAbstract:Thunderclap Headache is most commonly associated with subarachnoid haemorrhage or other acute intracranial pathology. It’s typically investigated with head imaging and lumbar puncture. We are presenting here the case of spontaneous cervical epidural haematoma manifesting as Thunderclap Headache. This pathology could be missed by following standard investigations of Thunderclap Headache and highlighting importance of through clinical history. 86 year old man presented to Emergency Department with Thunderclap Headache and loss of consciousness. Patient developed severe occipital Headache while leaving the bath than lost consciousness. After waking up he was unable to stand up, his lower legs felt numb and weak. Headache gradually improved within 30 min. His CT head after arrival to A and E didn’t show any acute intracranial pathology. CSF was normal, xantochromia was negative. Within 48 hours patient recovered almost completely. Was able to mobilise independently and was considered fit for discharge by medical team. After neurology review MRI scan of cervical spine was organised revealing spontaneous cervical epidural haematoma.
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PO027 Spontaneous cervical epidural haematoma presenting as Thunderclap Headache – case presentation
Journal of Neurology Neurosurgery and Psychiatry, 2017Co-Authors: Barbara Wysota, A C Williams, Tom HaytonAbstract:Thunderclap Headache is most commonly associated with subarachnoid haemorrhage or other acute intracranial pathology. It’s typically investigated with head imaging and lumbar puncture. We are presenting here the case of spontaneous cervical epidural haematoma manifesting as Thunderclap Headache. This pathology could be missed by following standard investigations of Thunderclap Headache and highlighting importance of through clinical history. 86 year old man presented to Emergency Department with Thunderclap Headache and loss of consciousness. Patient developed severe occipital Headache while leaving the bath than lost consciousness. After waking up he was unable to stand up, his lower legs felt numb and weak. Headache gradually improved within 30 min. His CT head after arrival to A and E didn’t show any acute intracranial pathology. CSF was normal, xantochromia was negative. Within 48 hours patient recovered almost completely. Was able to mobilise independently and was considered fit for discharge by medical team. After neurology review MRI scan of cervical spine was organised revealing spontaneous cervical epidural haematoma.
Jiingfeng Lirng - One of the best experts on this subject based on the ideXlab platform.
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bath related Thunderclap Headache a study of 21 consecutive patients
Cephalalgia, 2008Co-Authors: Shuujiun Wang, Jiingfeng Lirng, Zinan Wu, Shihpin ChenAbstract:We consecutively recruited 21 patients (all women, mean 54 ± 8 years) with bath-related Thunderclap Headache (BRTH). Thirteen of them were in menopause, two had just ceased hormonal therapy, and one was at 3 months postpartum. Bathing was the initial trigger for Thunderclap Headaches in nine patients (43%). Many patients (n = 15, 71%) had other non-bath-related attacks. Most patients (n = 18, 86%) reported that the Headache occurred immediately when water was sprayed over their body, with warm water (52%) as the most common. During the disease course [mean 14 days (6–34)], the mean number of BRTH was 5.1 ± 3.6 attacks. Nineteen patients (90%) changed bathing habits to prevent attacks. Thirteen patients (62%) had magnetic resonance angiography vasoconstrictions, and two of them (15%) developed reversible posterior encephalopathy. None of the patients without vasoconstrictions had this complication. Nimodipine was effective in stopping further attacks in 84% (16/19) treated patients. No relapse was reported at a mean follow-up of 30 months. BRTH occurred exclusively in women and predominantly in middle age. Deficiency or fluctuation of female sex hormones may play a role. About 60% patients showed cerebral vasospasms, fulfilling the diagnosis of reversible cerebral vasoconstriction syndrome and indicating a risk of posterior encephalopathy.
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Bath‐related Thunderclap Headache: a study of 21 consecutive patients
Cephalalgia, 2008Co-Authors: Shuujiun Wang, Zinan Wu, Shihpin Chen, Jiingfeng LirngAbstract:We consecutively recruited 21 patients (all women, mean 54 ± 8 years) with bath-related Thunderclap Headache (BRTH). Thirteen of them were in menopause, two had just ceased hormonal therapy, and one was at 3 months postpartum. Bathing was the initial trigger for Thunderclap Headaches in nine patients (43%). Many patients (n = 15, 71%) had other non-bath-related attacks. Most patients (n = 18, 86%) reported that the Headache occurred immediately when water was sprayed over their body, with warm water (52%) as the most common. During the disease course [mean 14 days (6–34)], the mean number of BRTH was 5.1 ± 3.6 attacks. Nineteen patients (90%) changed bathing habits to prevent attacks. Thirteen patients (62%) had magnetic resonance angiography vasoconstrictions, and two of them (15%) developed reversible posterior encephalopathy. None of the patients without vasoconstrictions had this complication. Nimodipine was effective in stopping further attacks in 84% (16/19) treated patients. No relapse was reported at a mean follow-up of 30 months. BRTH occurred exclusively in women and predominantly in middle age. Deficiency or fluctuation of female sex hormones may play a role. About 60% patients showed cerebral vasospasms, fulfilling the diagnosis of reversible cerebral vasoconstriction syndrome and indicating a risk of posterior encephalopathy.
-
recurrent primary Thunderclap Headache and benign cns angiopathy spectra of the same disorder
Neurology, 2006Co-Authors: Shihpin Chen, Jiingfeng Lirng, Fengchi Chang, Shuujiun WangAbstract:Objectives: To investigate the clinical pictures of patients with recurrent Thunderclap Headaches of unknown etiology and to field-test two relevant International Classification of Headache Disorders , 2nd edition (ICHD-II) criteria, i.e., primary Thunderclap Headache (Code 4.6) and benign (or reversible) angiopathy of the CNS (Code 6.7.3). Methods: We prospectively recruited patients presenting with idiopathic recurrent Thunderclap Headaches from a hospital-based Headache clinic. Detailed histories, neurologic examinations, and MRIs and magnetic resonance angiographies (MRAs) were performed in all patients to exclude secondary causes. Patients with cerebral vasoconstriction received serial MRA follow-up. Results: Fifty-six consecutive patients (51 female/5 male, mean age 49.6 ± 9.8 [range 22 to 76] years) were enrolled. Segmental vasoconstriction (or benign CNS angiopathy) was found in 22 patients (39%). Thunderclap Headache recurred in all patients with a median frequency of 0.7 times per day for a median period of 14 days (range 6 to 86 days). The median duration for each single attack was 3 hours. Most patients (84%) reported at least one trigger. Nimodipine effectively aborted further attacks in 83% of the treated patients. Headache attacks subsided within 3 months. Four patients (7%) developed ischemic complications. Patients with and without vasoconstriction based on MRA images were similar regarding demographics and Headache profile. Except for the duration criterion, our patients generally mapped well into the proposed ICHD-II criteria. Conclusions: This study suggests that the two diagnostic entities proposed by the ICHD-II may present different spectra of the same disorder. The distinct Headache profile may help physicians quickly recognize this disabling Headache disorder with risk of stroke and provide timely treatment.
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nimodipine for treatment of primary Thunderclap Headache
Neurology, 2004Co-Authors: Shiangru Lu, Yichu Liao, Jiingfeng Lirng, Shuujiun WangAbstract:Eleven patients with primary Thunderclap Headache (TCH) were treated with oral nimodipine 30 to 60 mg every 4 hours or IV nimodipine 0.5 to 2 mg/h if the oral regimen failed or images showed cerebral vasospasm. With oral nimodipine, Headache did not recur in the nine patients without vasospasm. IV nimodipine was given in two patients with vasospasm, including one who developed ischemic stroke. Nimodipine may be effective for TCH. Vasospasm may warrant IV nimodipine.
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bathing Headache a variant of idiopathic Thunderclap Headache
Cephalalgia, 2003Co-Authors: Yichu Liao, Shiangru Lu, Jiingfeng Lirng, Zinan Wu, Shuujiun WangAbstract:Bathing Headache is rarely described in literature. We report four middle-aged Taiwanese women who developed severe throbbing Headache with maximum intensity of onset during bathing. Diffuse cerebral vasospasm was demonstrated in one of them. All their Headaches resolved spontaneously (n = 1) or after nimodipine treatment (n = 3). Except for one patient with vasospasm in whom reversible posterior leukoencephalopathy and an asymptomatic cerebellar infarction developed, the others recovered without any complications. The clinical profile of bathing Headache points to idiopathic Thunderclap Headache. It may not be as benign as previously reported. Nimodipine might be effective in treatment of this special Headache syndrome.
