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High-Resolution Vessel Wall Imaging for a Differential Diagnosis of Thunderclap Headaches

      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” (
      • Long D.
      • Koyfman A.
      • Long B.
      The thunderclap headache: approach and management in the emergency department.
      ). 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.
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