Thunderclap Headache

Рет қаралды 8,068

The Neurophile (by Rutgers RWJMS Neurology)

Күн бұрын

This video is intended to serve as an overview of the approach to diagnosing a patient with thunderclap headache (fastest "worst headache" of life). Learners will define the thunderclap headache, review three major categories of dangerous pathologies (five cerebrovascular pathologies, three disorders causing intracranial pressure dysregulation, and one type of cerebral infection) and review the structure and function of the neurovascular unit and the associated disorders. We will also discuss CT-based early diagnostic workup (non-contrast head CT and CTA with contrast) for a patient with thunderclap headache, and briefly review the management and outcomes of one particular cause of thunderclap headache - reversible cerebral vasoconstruction syndrome. The video is summarized with a protocolized approach.
00:00 - INTRO
00:58 - OBJECTIVES
01:49 - CASE
03:27 - DEFINITION of Thunderclap Headache
06:17 - Pathological DIFFERENTIAL DIAGNOSIS
08:46 - Cerebrovascular Pathologies
10:25 - Aneurysmal Subarachnoid Hemorrhage
15:15 - Reversible Cerebral Vasoconstriction Syndrome
17:27 - Spontaneous Cervical Dissections
20:29 - Neurovascular Unit and Disorders of Vascular Tone
22:18 - Autoregulation Curve
23:28 - Posterior Reversible Encephalopathy Syndrome
25:47 - Cerebral Venous Thrombosis
28:46 - Intracranial Pressure Abnormalities
33:44 - Cerebral infections
38:30 - DIAGNOSTIC WORK-UP
38:35 - Non-contrast Head CT
44:08 - CT Angiogram with contrast
50:50 - BACK TO THE CASE...
53:51 - RCVS2 score
54:39 - MANAGEMENT AND OUTCOMES of RCVS
57:39 - SUMMARY/ALGORITHM
Created, produced and narrated by:
Abigail Knowles
MD Candidate, Class of 2024
Rutgers Robert Wood Johnson Medical School
with
Igor Rybinnik MD
Associate Professor
Neurology Clerkship Director
Division of Stroke and Critical Care
Rutgers Robert Wood Johnson Medical School
Content experts:
Ram Gowda MD, Igor Rybinnik MD
Division of Stroke and Neurocritical Care
Department of Neurology
Rutgers Robert Wood Johnson Medical School
Images adapted from:
- Hendricks BK, Hartman J, Cohen-Gadol AA. Operative Neurosurg 2018;15(6):613-23
- Brisman JL, Song JK, Newell DW. NEJM 2006;355:928-39
- Adapted from Schievink WI. NEJM 2001;344(12):898
- Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012
- Coelho-Santos V, Shih AY. WIREs Dev Biol 2020;9:e363.
- Kaplan L, Chow BW, Gu C. Nature 2020, 21, 416-431
- Gorelick PB, et al. Stroke 2017;48:e00
- Gregg L, 2020
- Houk JL, et al. JNS 2021,136(6):1796-1803
- Farb RI, et al. AJNR 2019;40:745-53
- Case courtesy of Albakheet SS, Radiopaedia.org, rID 52865
- Case courtesy of Di Muzio B, Radiopaedia.org, rID 55441
- Case courtesy of Gaillard F, Radiopaedia.org, rID 169151
References:
- Goldstein JN, et al. Cephalalgia 2006;26(6):684-690
- Cephalalgia 2018 Jan;38(1):1-211
- Devenney E, et al. J Headache Pain 2014;15:49
- Roberts T, et al. Emerg Med J 2022;39:803-809
- Debette S, CADISP Group. Neurology 2011 Sep 20;77(12):1174-81
- Bejot Y, et al. Stroke 2014;45:37-41
- Rose JC, Mayer SA. Neurocrit Care 2004;1:287-99
- Lidington D, et al. Front Neurol 2021;12:1-29
- Anderson RG, et al. Frontiers of Neurology 2020;11(463):1-10
- Duman T, et al. JSCVD 2017;26(8):1848-57
- Beaumont TL, et al. J Neurosurg 2016;125:1420-1430
- O’Neill AH, et al. J of Clinical Neuroscience 2018;53:122-126
- Donegan D, Erickson D. J of the Endocrine Society 2022;6:1-10
- Schievink WI. NEJM 2021;385:2173-8
- Dobrocky T, et al. Lancet Neurol 2022;21:369-80
- Dobrocky T, et al. JAMA Neurol 2019;76(5):580-587
- Cheema S, et al. J Neurol Neurosurg Psych 2023;94:835-843
- Roberts T, et al. Emerg Med J 2022;39:803-9
- Walton M, et al. Emerg Med J 2022;39:818-25
- Perry JJ, et al. JAMA 2013;310:1248-55
- Rocha EA, et al. Neurology 2019;92(7):e639-47
- John S, et al. Cephalalgia 2016;36(4):387
Music, Sounds:
- "Feels" by Patrick Patrikios
DISCLAIMER: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, RWJBarnabus Health, or Rutgers University as a whole.

Пікірлер: 38

@frankrobert1917 21 күн бұрын

the most comprehensive and best neurology lectures in KZfaq channel.

@theneurophile 21 күн бұрын

Thank you!

@vxp999 6 ай бұрын

Happiest days of my life is the days when the neurophile posts new vides!🙏🏽 Finally you guys are back🥳

@theneurophile 6 ай бұрын

I am sorry that it took so long to make this video.

@richardbocek4399 6 ай бұрын

@@theneurophile Is it Christmas again? :D

@doug5203 5 ай бұрын

I'm a current neuroradiology fellow who graduated from RWJMS, which is how I stumbled upon this. Have got to say, seriously impressive, polished work on your case presentations. I can only imagine the hours that went into it.

@theneurophile 5 ай бұрын

Thank you! If you have some time and a topic you find interesting, consider collaborating for a video.

@tao072002 22 күн бұрын

I'm an internal medicine resident and unfortunately, neurology is placed off to the side in our training, so these videos are so so helpful for teaching on neurology topics. Thanks Neurophile!

@theneurophile 22 күн бұрын

This is a sad fact in many places - medicine residents don’t get enough neurology. I applaud your initiative. Keep learning!

@rayan5862 5 ай бұрын

I just discovered your channel, it's amazing, I hope you make a video about lesion localisation

@theneurophile 5 ай бұрын

Welcome. Yes we are working on a large neuroanatomy/localization/neurological examination video.

@thiagoschernikau4769 6 ай бұрын

I was just wondering what to study today and stumbled upon yet another one of your fantastic videos. Keep up the great work!

@theneurophile 6 ай бұрын

Glad to hear it!

@ludvigmansson9875 6 ай бұрын

Wonderful presentation. As a medical student, these videos are superb! Thank you!

@georgebashour4333 6 ай бұрын

Another neurophile video, another happy day in my life... Also, this is on time with me revising neurology for my medical school national exams💙 Thank you for these great lectures

@lavendergooms7958 6 ай бұрын

Excellent presentation.

@desertdweller129 6 ай бұрын

thank you for this video ❤

@rebecakinomotomartinez5446 6 ай бұрын

Thank you!!

@user-bw2oi9bs9g 4 ай бұрын

nice radiology examples

@caiyu538 3 ай бұрын

Very great kecture.

@MBBSZaraHutKay 6 ай бұрын

Love and Respect❤

@abdou.b3259 4 ай бұрын

Doctor, I am a medical student. Today, a 69-year-old woman came to us and said that she suffers from slurred speech compared to the past, and that she has a curvature in the back, weight loss, and feels tired and she have hypotonia. And Mri was normal

@kimberleymarkova3641 5 ай бұрын

Most people don't even get out of their house when hit by the Thunderclap, onset of pain to peak (10/10), less than 3 minutes, weakness, collapsed, nausea, instantly unconscious. Was on SSRIs. NASAH June 2015. Survived, thank God. 6 weeks in hospital (Salpetriere in Paris) ❤ who saved my life

@theneurophile 5 ай бұрын

Thank you for that perspective. I hope you are feeling better now.

@kaazooyii 3 ай бұрын

Love it…

@YairGatt 4 ай бұрын

Wonderful talk, really helpful and complements the amazing headaches talk on this channel! A small question - a couple of years ago you mentioned a new MS video was in the works, is there any expected release soon?

@theneurophile 4 ай бұрын

Unfortunately we are waiting for new MS faculty to join us, who will serve as content experts. Hopefully the talk will be ready at the end of the summer.

@dr.nikhilagrawal3854 4 ай бұрын

Please make a video on approach to neuropathy

@xxamulyaxx 6 ай бұрын

wow, just wow

@JuanCarlosTabao-xj9eq 2 ай бұрын

❤❤❤❤❤

@JuanCarlosTabao-xj9eq 2 ай бұрын

❤❤❤❤❤❤❤

@JuanCarlosTabao-xj9eq 2 ай бұрын

❤❤❤❤❤🎉

@A99286 5 ай бұрын

Does doing push ups for blood flow cause damage to neck nerve which have too much pain

@theneurophile 5 ай бұрын

Exercise is usually helpful in reducing stroke risk.

@A99286 5 ай бұрын

@@theneurophile I mean neural nerve not blood vessel

@theneurophile 5 ай бұрын

There are many nerves in the neck. You can certainly overdo physical activity and injure them. However, you should always listen to your body and to your doctor. If you are recovering from a neurological injury, having a physical therapist to guide you in the level of physical activity is also helpful.