Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage.

Abstract:

OBJECTIVE:An excruciating headache of instantaneous onset is known as a thunderclap headache. A subarachnoid hemorrhage is the prototypical cause, but other serious disorders may also present with a thunderclap headache, including cerebral venous sinus thrombosis, carotid artery dissection, and pituitary apoplexy. We report a group of patients with thunderclap headaches as the initial manifestation of spontaneous intracranial hypotension caused by a spinal cerebrospinal fluid leak. METHODS:Among 28 patients with spontaneous intracranial hypotension due to a documented spinal cerebrospinal fluid leak, four (14%) initially experienced an excruciating headaches of instantaneous onset. RESULTS:The mean age of the four patients (two men and two women) was 35 years (range, 24-45 yr). Nuchal rigidity was present in the three patients who sought early medical attention, and they underwent emergency computed tomographic scanning, lumbar puncture, and cerebral angiography to rule out an aneurysmal subarachnoid hemorrhage. The delay between the onset of headache and diagnosis of intracranial hypotension ranged from 4 days to 5 weeks. A fourth patient did not seek medical attention until 1 month after the ictus. CONCLUSION:Spontaneous intracranial hypotension should be included in the differential diagnosis of thunderclap headache, even when meningismus is present.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Schievink WI,Wijdicks EF,Meyer FB,Sonntag VK

doi

10.1097/00006123-200103000-00009

keywords:

subject

Has Abstract

pub_date

2001-03-01 00:00:00

pages

513-6; discussion 516-7

issue

3

eissn

0148-396X

issn

1524-4040

journal_volume

48

pub_type

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