Search

Thunderclap headache is most commonly associated with subarachnoid haemorrhage or other acute intracranial pathology. It’s typically investigated with head imaging and lumbar puncture. We are presenting here the case of spontaneous cervical epidural haematoma manifesting as thunderclap headache. This pathology could be missed by following standard investigations of thunderclap headache and highlighting importance of through clinical history. 86 year old man presented to Emergency Department with thunderclap headache and loss of consciousness. Patient developed severe occipital headache while leaving the bath than lost consciousness. After waking up he was unable to stand up, his lower legs felt numb and weak. Headache gradually improved within 30 min. His CT head after arrival to A and E didn’t show any acute intracranial pathology. CSF was normal, xantochromia was negative. Within 48 hours patient recovered almost completely. Was able to mobilise independently and was considered fit for discharge by medical team. After neurology review MRI scan of cervical spine was organised revealing spontaneous cervical epidural haematoma.

The hypothalamus and myocardium of 12 patients who had died after a subarachnoid haemorrhage, and of six patients who had died from other intracranial pathology were examined. Only in the patients who had died from subarachnoid haemorrhage were histological lesions found in both the hypothalamus and myocardium. The possible significance of these findings is discussed with particular reference to the sympathetic nervous system.

Unsuspected intracranial pathology was demonstrated in 12 of 136 chronic schizophrenic patients examined by computed tomography (CT). Seven cases of cerebral infarction were found, and one each of porencephalic cyst, meningioma, cystic enlargement of the pineal body, and two of subdural haematoma. Attention is drawn to the value of CT in demonstrating organic disease in schizophrenia.