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Neuroimaging Clin N Am. 2018 Aug;28(3):335-351. doi: 10.1016/j.nic.2018.03.002. Epub 2018 Jun 8.

The Patient with Thunderclap Headache.

Author information

1
Department of Radiology and Biomedical Imaging, Yale School of Medicine, The Imaging Clinical Effectiveness and Outcomes Research, Northwell Health, 55 York Street, New Haven, CT 06511, USA. Electronic address: ajay.malhotra@yale.edu.
2
Department of Radiology and Biomedical Imaging, Yale School of Medicine, 55 York Street, New Haven, CT 06511, USA.
3
Interventional Neuroradiology, University of Maryland School of Medicine, 22 South Greene Street, Room N2e23, Baltimore, MD 21201, USA.
4
Department of Radiology, The Imaging Clinical Effectiveness and Outcomes Research, Northwell Health, NSUH, 300 Community Drive, Manhasset, NY 11030, USA.

Abstract

Thunderclap headache is a common presentation in the emergency department and, although multiple causes have been described, subarachnoid hemorrhage (SAH) is the primary concern and early diagnosis is critical. CT is highly sensitive if performed within 6 hours of onset. Patients with aneurysmal or perimesencephalic SAH should be evaluated with CT angiography. Further work-up should be guided by the pattern of blood. Patients with negative CT angiography may be further evaluated with MR imaging, especially patients with peripheral convexity SAH.

KEYWORDS:

Intracranial aneurysm; Lumbar puncture; Subarachnoid hemorrhage; Thunderclap headache

PMID:
30007749
DOI:
10.1016/j.nic.2018.03.002
[Indexed for MEDLINE]

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