thunderclap headache

Reversible cerebral vasoconstriction syndrome (RCVS) is an nderdiagnosed condition which usually presents as severe headache with or without neurological deficit. We report the case of a 55-year-old woman who  presented with headache and multifocal intracerebral haemorrhage. We review the literature regarding the presentation, pathophysiology and management of RCVS and discuss how to differentiate it from cerebral vasculitis.

Keywords Cerebral vasculitis, reversible cerebral vasoconstriction syndrome, thunderclap headache

Introduction and aims: Traditionally, neurologically pristine patients with a thunderclap headache are investigated with a non-contrast computed tomography (CT) brain scan, which if negative is followed by a lumbar puncture (LP) to exclude important secondary causes, particularly subarachnoid haemorrhage (SAH). However, misdiagnosis of such patients is still a cause of significant human and financial cost and a regular reason for medical litigation.