J Korean Soc Emerg Med.  2012 Oct;23(5):745-749.

A Case of Right Middle Cerebral Artery Infarction Presenting as Thunderclap Headache

• Han SD
• Jo YS
• Choi JY
• Kim SK
• Kim JY

Abstract

Thunderclap headache refers to a sudden and severe headache that comes unexpectedly, reminding one of a clap of thunder. The initial description of this type of headache was in association with an unruptured intracranial aneurysm. It 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. A formula for diagnostic assessment of thunderclap headache, such as brain computed tomographic scan and spinal tap, should be established. We experienced a case of cerebral infarction presented with thunderclap headache, diagnosed using diffusion weighted magnetic resonance imaging. We suggest that, even when these patients have shown non-specific findings on neurological examination, brain computed tomography, and cerebrospinal fluid analysis, diffusion MRI should be considered for differential diagnosis of thunderclap headache in emergency medical services.

Keyword

Thunderclap headache; Cerebral infarction; Diffusion magnetic resonance imaging; Emergency medical services

MeSH Terms

Arteries
Brain
Cerebral Infarction
Diagnosis, Differential
Diffusion
Diffusion Magnetic Resonance Imaging
Emergency Medical Services
Headache
Headache Disorders, Primary
Hematoma
Humans
Infarction, Middle Cerebral Artery
Intracranial Aneurysm
Intracranial Hypotension
Leukoencephalopathies
Magnetic Resonance Imaging
Neurologic Examination
Pituitary Apoplexy
Spinal Puncture
Subarachnoid Hemorrhage
Venous Thrombosis