Thunderclap headache: It is always sub-arachnoid hemorrhage. Is it? - A case report and Review.
BACKGROUND
Spontaneous intracranial hypotension (SIH) is one of the relatively misdiagnosed pathophysiological entities by virtue of its presentation. SIH is a condition involving reduced intracranial pressure usually secondary to dural tear. There is recent increase in reporting of its varied presentation in literature. Critical care physicians and neurosurgeons are recognizing it in higher numbers than before. SIH is characterized by sudden onset of orthostatic headache and may be associated with neck stiffness, nausea, vomiting, tinnitus, deafness, and cognitive abnormalities. Since its imaging characteristics resemble classic subdural hematoma from other causes wrong diagnosis and intervention might have devastating outcome.


METHODS
Here we discuss a case presented to us with severe headache of sudden onset without any associated problems. Patient was initially being treated as sinusitis and later diagnosed as bilateral subdural hematoma and surgical intervention was being considered. Thorough history taking and physical examination lead to strong suspicion of intracranial hypotension (IH) and patient showed dramatic improvement with epidural blood patch.


CONCLUSIONS
IH is a commonly misdiagnosed entity. A high index of suspicion is required for timely diagnosis, in order to minimize unwanted therapeutic interventions that can worsen the patient's condition and to help initiate early and simple interventions.
Department of Critical Care, Gopala Gowda Shanthaveri Memorial Hospitals, Mysore, Karnataka, India.
Raghunath
R
Aladakatti
Department of Critical Care, Gopala Gowda Shanthaveri Memorial Hospitals, Mysore, Karnataka, India.
Laxmikant B
LB
Sannakki
Department of Neurology and Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
Peter Y
PY
Cai
Department of Neurology and Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
Roselle
R
Derequito
Diagnosis; hypotension; intracranial; presentation; spontaneous