Differential diagnoses of ⛈️Thunderclap headache⚡ are indeed thunderous.
Here is a brief 🧵.
@AaronLBerkowitz @caseyalbin @rabihmgeha @DxRxEdu @sargsyanz @AnnKumfer @rav7ks @gabifpucci @jackpenner @RosenelliEM @Sharminzi @CPSolvers
#MedTwitter #NeuroTwitter #Neurology
Here is a brief 🧵.
@AaronLBerkowitz @caseyalbin @rabihmgeha @DxRxEdu @sargsyanz @AnnKumfer @rav7ks @gabifpucci @jackpenner @RosenelliEM @Sharminzi @CPSolvers
#MedTwitter #NeuroTwitter #Neurology
#1 Subarachnoid hemorrhage
Aneurysmal SAH
Cortical SAH (due to RCVS)
- Seizures
- Meningismus
- Altered mental status
- RBC & Xanthochromia in CSF
Look out for possible
sequelae: Rebleeding, vasospasm & ischemia, hydrocephalus
#MedTwitter #Neurology
nejm.org
Aneurysmal SAH
Cortical SAH (due to RCVS)
- Seizures
- Meningismus
- Altered mental status
- RBC & Xanthochromia in CSF
Look out for possible
sequelae: Rebleeding, vasospasm & ischemia, hydrocephalus
#MedTwitter #Neurology
nejm.org
#2 RCVS
-Multifocal multivessel vasoconstriction (string of beads)
-Recurrent episodes (triggers- bathing, Valsalva, bending, urinating, strong emotions)
Risk factors: Postpartum state, SSRIs, Calcineurin inhibitors, vasoactive drugs, sympathetic overactive states
#MedTwitter
-Multifocal multivessel vasoconstriction (string of beads)
-Recurrent episodes (triggers- bathing, Valsalva, bending, urinating, strong emotions)
Risk factors: Postpartum state, SSRIs, Calcineurin inhibitors, vasoactive drugs, sympathetic overactive states
#MedTwitter
#3 Cerebral Venous sinus thrombosis
-Focal neurologic deficits
-Headache
-Visual loss
-Dense triangle sign and cord sign on CT
-Hemorrhagic infarction
Risk factors: Pregnancy, hypercoagulable states, PNH, nephrotic syndrome, OCP, Infections, Behcet's.
#MedTwitter
-Focal neurologic deficits
-Headache
-Visual loss
-Dense triangle sign and cord sign on CT
-Hemorrhagic infarction
Risk factors: Pregnancy, hypercoagulable states, PNH, nephrotic syndrome, OCP, Infections, Behcet's.
#MedTwitter
#4 Arterial dissection (Cervical & Vertebral)
- Neck pain
- TIA/Stroke
- Retinal infarcts
- Horner syndrome
Can be spontaneous/idiopathic or due to neck manipulation, trauma, HTN, FMD, vasculitis, drugs.
#MedTwitter #Neurology
- Neck pain
- TIA/Stroke
- Retinal infarcts
- Horner syndrome
Can be spontaneous/idiopathic or due to neck manipulation, trauma, HTN, FMD, vasculitis, drugs.
#MedTwitter #Neurology
#5 Pituitary apoplexy
- Hemorrhage into the pituitary tumor
- Nelson syndrome (following adrenalectomy)
Presents as headache, nausea, vomiting, visual loss, diplopia, and hormone deficits, especially cortisol due to loss of ACTH secretion.
#MedTwitter #Neurology
- Hemorrhage into the pituitary tumor
- Nelson syndrome (following adrenalectomy)
Presents as headache, nausea, vomiting, visual loss, diplopia, and hormone deficits, especially cortisol due to loss of ACTH secretion.
#MedTwitter #Neurology
#6 Spontaneous intracranial hypotension
Also called sagging brain syndrome
- Orthostatic headache
- Auditory muffling & tinnitus
- Dizziness
- Visual changes
Presents with diffuse and smooth pachymeningeal enhancement.
#MedTwitter #Neurology
Also called sagging brain syndrome
- Orthostatic headache
- Auditory muffling & tinnitus
- Dizziness
- Visual changes
Presents with diffuse and smooth pachymeningeal enhancement.
#MedTwitter #Neurology
#7 Etiologies causing or associated with raised ICP
- Aqueductal stenosis
- Colloid cyst of the third ventricle
- Brain tumor
- Intracranial hemorrhage
- Aqueductal stenosis
- Colloid cyst of the third ventricle
- Brain tumor
- Intracranial hemorrhage
#8 Vascular causes
- Ischemic stroke
- Hypertensive crisis
- Subdural hematoma
- Giant cell arteritis
- Spinal epidural hematoma
- Retroclival hematoma
- Ischemic stroke
- Hypertensive crisis
- Subdural hematoma
- Giant cell arteritis
- Spinal epidural hematoma
- Retroclival hematoma
#9 Miscellaneous
- Complicated sinusitis
- Pheochromocytoma
- Cardiac cephalgia
#MedTwitter #Neurology
- Complicated sinusitis
- Pheochromocytoma
- Cardiac cephalgia
#MedTwitter #Neurology
Here is an excellent paper
journals.lww.com
Thanks for reading.
Any insights or suggestions appreciated
@nsrosenberg @ASanchez_PS @MariaMjaleman @valeroldan23 @DrSakhii
journals.lww.com
Thanks for reading.
Any insights or suggestions appreciated
@nsrosenberg @ASanchez_PS @MariaMjaleman @valeroldan23 @DrSakhii
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