Department of Neurology, School of Medicine, Konkuk University, Chungju Hospital, Chungju, Republic of Korea.
Neurol Sci. 2012 Apr;33(2):321-3. doi: 10.1007/s10072-011-0673-6. Epub 2011 Jul 1.
Thunderclap headache (TCH) refers to a sudden-onset, severe headache that features in subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous thrombosis, pituitary apoplexy, cervical artery dissection, and hypertensive reversible posterior leukoencephalopathy. TCH is a rare manifestation in cerebral or cerebellar infarctions. Herein, we report on a 60-year-old woman with a thunderclap headache as the first symptom of cerebellar infarction, in the absence of abnormal findings in the brain computed tomography (CT), CT angiography, and lumbar puncture. An urgent brain MRI showed an acute infarction of the right cerebellar hemisphere. The next day, the patient presented with right side ataxia. In emergency cases presenting with thunderclap headache, one should consider an expanded evaluation and/or close observation, with frequent neurological examinations, even though the findings are normal on the initial neurological examination, cerebrospinal fluid analysis, and brain CT.
雷击样头痛（TCH）是指一种突发性、剧烈头痛，可见于蛛网膜下腔出血、未破裂颅内动脉瘤、脑静脉血栓形成、垂体卒中、颈动脉夹层和高血压性可逆性后部白质脑病。TCH 是脑梗死或小脑梗死的一种罕见表现。在此，我们报告一例 60 岁女性，以雷击样头痛为首发症状的小脑梗死，头颅 CT（CT）平扫、CT 血管成像和腰椎穿刺均未见异常。紧急脑部 MRI 显示右侧小脑半球急性梗死。次日，患者出现右侧共济失调。对于以雷击样头痛为首发表现的急症患者，即使初始神经检查、脑脊液分析和脑 CT 未见异常，也应考虑进行扩展评估和/或密切观察，并进行频繁的神经系统检查。
