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Taerim Kim, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Won Young Kim
OBJECTIVE: Reversible cerebral vasoconstriction syndrome (RCVS) is an underestimated cause of thunderclap headache that shares many characteristics with subarachnoid hemorrhage (SAH). This fact makes the two easily confused by emergency physicians. This study evaluated the clinical manifestations, radiological features, and outcomes of patients with RCVS. METHODS: The electronic medical records of 18 patients meeting the diagnostic criteria of RCVS at our emergency department between January 2013 and December 2014 were retrospectively reviewed...
December 2015: Clin Exp Emerg Med
Michael K Abraham, Wan-Tsu Wendy Chang
Aneurysmal subarachnoid hemorrhage (SAH) is a neurological emergency with high risk of neurological decline and death. Although the presentation of a thunderclap headache or the worst headache of a patient's life easily triggers the evaluation for SAH, subtle presentations are still missed. The gold standard for diagnostic evaluation of SAH remains noncontrast head computed tomography (CT) followed by lumbar puncture if the CT is negative for SAH. Management of patients with SAH follows standard resuscitation of critically ill patients with the emphasis on reducing risks of rebleeding and avoiding secondary brain injuries...
November 2016: Emergency Medicine Clinics of North America
Ramin R Tabatabai, Stuart P Swadron
There are a number of dangerous secondary causes of headaches that are life, limb, brain, or vision threatening that emergency physicians must consider in patients presenting with acute headache. Careful history and physical examination targeted at these important secondary causes of headache will help to avoid misdiagnosis in these patients. Patients with acute thunderclap headache have a differential diagnosis beyond subarachnoid hemorrhage. Considering the "context" of headache "PLUS" some other symptom or sign is one strategy to help focus the differential diagnosis...
November 2016: Emergency Medicine Clinics of North America
Makarand Kulkarni, Vinay Chauhan, Sudheer Shetty
Reversible cerebral vasoconstriction syndrome (RCVS) is a disease characterized by thunderclap headache with severe vasospasm of middle sized vessels of circle of Willis or the extracranial circulation which spontaneously revert back. We report a middle aged female with severe headache and vasospasm of the vertebral arteries and vessels of circle of Willis causing multiple cerebral infarcts. The vasospasm resolved within 3 months.
June 2016: Journal of the Association of Physicians of India
Elisabeth B Marsh, Wendy C Ziai, Rafael H Llinas
INTRODUCTION: Reversible cerebral vasoconstriction syndrome (RCVS) typically affects young patients and left untreated can result in hemorrhage or ischemic stroke. Though the disorder has been well characterized in the literature, the most appropriate way to diagnose, treat, and evaluate therapeutic response remains unclear. In previous studies, transcranial Doppler ultrasound (TCD) has shown elevated velocities indicative of vasospasm. This imaging modality is noninvasive and inexpensive; an attractive option for diagnosis and therapeutic monitoring if it is sensitive enough to detect changes in the acute setting given that RCVS often affects the distal vessels early in the course of disease...
May 2016: Case Reports in Neurology
Deborah Tepper
No abstract text is available yet for this article.
October 2016: Headache
M Trolliet, A Sevely, J-F Albucher, N Nasr, C Hachon Lecamus, K Deiva, E Cheuret
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches with diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. We report on a case of a 13-year-old boy presenting with acute severe headaches, triggered by physical exertion. His past medical history was uneventful. Moderate headache persisted between exacerbations for 4 weeks. He secondarily presented with signs of intracranial hypertension. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries...
September 14, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Jay H Levin, Jorge Benavides, Claudine Caddick, Kathleen Laurie, Janet Wilterdink, Shadi Yaghi, Brian Silver, Muhib Khan
BACKGROUND AND PURPOSE: Reversible cerebral vasoconstriction syndrome (RCVS) is a vascular headache disorder characterized by severe headaches with vasospasm of cerebral arteries. Transcranial Doppler ultrasonography (TCD) has been widely applied and validated in studying vasospasm of intracranial vessels, but the role of TCD in the diagnosis and monitoring of RCVS is less well established. We sought to determine the reliability of TCD for diagnosis and monitoring of RCVS. METHODS: Patients admitted to an inpatient neurology service between 2011 and 2014 with a discharge diagnosis of RCVS were retrospectively analyzed for demographics, neuroimaging, and functional outcomes...
September 1, 2016: Rhode Island Medical Journal
K Ravishankar
The term "thunderclap headache" (TCH) was first coined in 1986 by Day and Raskin to describe headache that was the presenting feature of an underlying unruptured cerebral aneurysm. The term is now well established to describe the abrupt onset headache seen with many other conditions and is also now included in The International Classification of Headache Disorders 3(rd) edition beta version rubric 4.4. An essential to label an acute headache as "TCH" and differentiate it from other "sudden onset, severe headaches" is the arbitrary time frame of 1 min from onset to peak intensity for "TCH...
July 2016: Annals of Indian Academy of Neurology
V Gilard, L Grangeon, E Guegan-Massardier, M Sallansonnet-Froment, D Maltête, S Derrey, F Proust
BACKGROUND AND OBJECTIVES: The symptomatic status of unruptured aneurysms has to be looked for. The objective of this retrospective case-control study was to identify the headache semiologic characteristics of symptomatic aneurysms during the 3 months prior to patient admission. PATIENTS AND METHODS: The case cohort was composed of 40 consecutive patients admitted for the treatment of a ruptured intracranial aneurysm (IA) and able to answer a standardized questionnaire by the same neurologist...
August 12, 2016: Neuro-Chirurgie
Akiyuki Hiraga, Yuya Aotsuka, Kyosuke Koide, Satoshi Kuwabara
BACKGROUND: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by segmental vasospasm. Vasoactive agents and childbirth have been reported as precipitating factors for RCVS; however, RCVS induced by altitude change or air travel has rarely been reported. CASE: We present a case of a 74-year-old woman who presented with thunderclap headache during airplane descent. Magnetic resonance angiography demonstrated segmental vasoconstriction that improved 9 days after onset...
August 12, 2016: Cephalalgia: An International Journal of Headache
Lou Grangeon, Gulden Ozel, Evelyne Guégan-Massardier, Romain Lefaucheur
Bath-related thunderclap headache (BRTH) is a rare entity, closed to reversible cerebral vasoconstriction syndrome. It is only described in middle-aged women and mainly Asiatic ethnic origins. Role of estrogen is consequently discussed. We report here a case of a 36-year-old man, admitted for five episodes of thunderclap headaches, triggered by hot shower. This is the first male case of BRTH, opposing only a hormonal hypothesis. Furthermore, this African patient consolidates the non-exclusivity of this affection to Asian ethnic origins...
August 4, 2016: Headache
Duangnapa Roongpiboonsopit, Kannikar Kongbunkiat, Kammant Phanthumchinda
Reversible cerebral vasoconstriction syndrome (RCVS), a recently recognized syndrome, is defined as an intermittent segmental vasospasm of cerebral arteries accompanied by thunderclap headache. The major complications of RCVS include ischemic or hemorrhagic stroke, which may cause morbidity and mortality. It is important to detect RCVS in clinical practice because misdiagnosis may lead to inappropriate treatment. In Thailand, there are only two reported cases of RCVS, which may reflect an underdiagnosis of this syndrome...
January 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Yukitaka Tanaka, Masahiko Tosaka, Hiroya Fujimaki, Fumiaki Honda, Yuhei Yoshimoto
BACKGROUND: The significance of sex- and age-related differences in the clinical course of spontaneous intracranial hypotension (SIH) was investigated. METHODS: We retrospectively studied 40 consecutive patients (female:male = 28:12, median age 41.5 years) treated under clinical diagnoses of SIH satisfying the International Classification of Headache Disorders 3rd edition criteria, including 37 patients (92.5%) with diffuse pachymeningeal enhancement. The patients were divided into two groups by age and sex, and the clinical and neuroimaging findings in each group were investigated...
September 2016: Headache
Nuri Jacoby, Ulrike Kaunzner, Marc Dinkin, Joseph Safdieh
This is a case of a 52-year-old man with a past medical history of 2 episodes of coital thunderclap headaches as well as recent cocaine, marijuana, and pseudoephedrine use, who presented with sudden, sharp, posterior headache associated with photophobia and phonophobia. His initial magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA) of the head, and magnetic resonance venography (MRV) of the head were all normal as well as a normal lumbar puncture. Given the multiple risk factors for reversible cerebral vasoconstriction syndrome (RCVS), the patient was treated for suspected RCVS, despite the normal imaging...
July 2016: Neurohospitalist
J David Avila
No abstract text is available yet for this article.
July 2016: Neurohospitalist
Kunal Agrawal, Kathy Burger, John F Rothrock
BACKGROUND: Although cerebral venous thrombosis/cerebral sinus thrombosis (CVT/CST) remains a relatively uncommon cause of stroke and other neurologic complications, the widespread availability of noninvasive brain imaging has led to an increase in its diagnosis. PURPOSE: Through a review and description of its epidemiology, clinical features and treatment, to heighten awareness of CVT/CST. METHODOLOGY: Via a systematic review of the more recently published medical literature relevant to the topic and focusing in particular on primary sources, we compiled data related to the incidence of CVT/CST and its diagnosis, treatment and prognosis...
September 2016: Headache
Andrew Barritt, Sarah Miller, Indran Davagnanam, Manjit Matharu
Thunderclap headache is a severe and acute headache that reaches maximum intensity in under one minute and lasts for more than five minutes. Subarachnoid haemorrhage (SAH) accounts for 10-25% of all thunderclap headaches and, despite advances in medical technology, has a 90-day mortality of 30%. Up to a quarter of cases of SAH are misdiagnosed, often through failure to follow guidance. Thunderclap headaches may be associated with symptoms such as photophobia, nausea, vomiting, neck pain, focal neurological symptoms or loss of consciousness...
April 2016: Practitioner
Ajay Malhotra, Xiao Wu, Howard P Forman, John H Burton
We are grateful for the opportunity to expand the discussion and respond to the comments expressed. The purpose for the economic modelling in our study was not to calculate absolute costs and utilities, but to highlight the key factors involved in the decision-making process in managing patients with thunderclap headache, including the prevalence of SAH, sensitivity of noncontrast CT (which may vary depending on time of scan since onset) and the incidence of SAH caused by aneurysms. Management strategies may have to be tailored accordingly, and the knowledge of how these factors influence the conclusions can help the treating physicians with decision-making and discussions with the patients...
June 17, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Justin M DeLange, Katherine Riordan, Srijana Zarkou
No abstract text is available yet for this article.
May 25, 2016: Cephalalgia: An International Journal of Headache
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