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J Korean Soc Emerg Med > Volume 23(5); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(5): 745-749.
A Case of Right Middle Cerebral Artery Infarction Presenting as Thunderclap Headache
Sang Don Han, Yoon Sik Jo, Jin Yong Choi, Shin Kyoung Kim, Jin Yong Kim
1Department of Neurology, Konkuk University School of Medicine, Chungju, Korea.
2Department of Rehabilitation Medicine, Konkuk University School of Medicine, Chungju, Korea.
3Department of Emergency Medicine, Konkuk University School of Medicine, Chungju, Korea. palenova@naver.com
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.
Key words: Thunderclap headache, Cerebral infarction, Diffusion magnetic resonance imaging, Emergency medical services
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