We read with great interest the article written by Long et al. and published in The Journal of Emergency Medicine entitled, “The Thunderclap Headache: Approach and Management in the Emergency Department”
(
1
). The authors provided an excellent review of the various conditions that can present
clinically in association with thunderclap headaches. The authors also proposed a
diagnostic algorithm for their diagnosis. However, we would like to discuss the role
of high-resolution vessel wall imaging (HR-VWI), a magnetic resonance imaging (MRI)
technique not mentioned by the authors, in the diagnosis of two conditions that can
present with thunderclap headache. These conditions are demonstrated in a case of
reversible cerebral vasoconstriction syndrome (RCVS) and in a case of vertebral artery
dissection, which we will describe here.To read this article in full you will need to make a payment
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References
- The thunderclap headache: approach and management in the emergency department.J Emerg Med. 2019; 56: 633-641
- Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology.AJNR Am J Neuroradiol. 2017; 38: 218-229
- Clinical interpretation of high-resolution vessel wall MRI of intracranial arterial diseases.Br J Radiol. 2016; 89: 20160496
- Intracranial vessel wall imaging for evaluation of steno-occlusive diseases and intracranial aneurysms.J Neuroradiol. 2017; 44: 123-134
- High-resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis.AJNR Am J Neuroradiol. 2014; 35: 1527-1532
- Vessel wall imaging of the intracranial and cervical carotid arteries.J Stroke. 2015; 17: 238-255
- Intracranial vessel wall MRI: an emerging technique with a multitude of uses.Top Magn Reson Imaging. 2016; 25: 41-47
- Imaging investigation of intracranial arterial dissecting aneurysms by using 3 T high-resolution MRI and DSA: from the interventional neuroradiologists' view.Acta Neurochir (Wien). 2014; 156: 515-525
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- The Thunderclap Headache: Approach and Management in the Emergency DepartmentJournal of Emergency MedicineVol. 56Issue 6
