A story of thundeclap headache and stroke

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Case Report

Author Details : Sakshi Puri*, Insha Aleena, Debabrata Chakraborty

Volume : 10, Issue : 2, Year : 2024

Article Page : 114-116

https://doi.org/10.18231/j.ijn.2024.024

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Abstract

Giant cell arteritis causes large and medium vessel vasculitis that can involve the aorta and great vessels. We report a case of a 59-year-old female with no known comorbidity who presented with complaints of sudden onset, sharp, severe right-sided headache for 15 days which was gradually progressive and not responding to any painkillers followed by acute onset left-sided weakness. On examination, she had reduced power in the left upper and lower limb, right temporal, parietal scalp tenderness, and low-volume temporal artery pulsation. MRI and MRA of the brain revealed a subcortical infarct in the right frontal subcortical region with normal cerebrospinal fluid findings. His ESR and CRP levels were raised and her hemoglobin level was low (vasculitis markers and other stroke workups were non-contributory). VEP showed moderate to severe retino-optic pathway dysfunction predominantly demyelinating type. We started aspirin, atorvastatin, and prednisolone as we suspected Giant cell arteritis (GCA). GCA is an unusual cause of ischaemic stroke (stroke prevalence is around 1.5% - 11% in GCA cases). In our case, the patient with no history of headache or stroke presented with ischaemic stroke in her very first presentation and was diagnosed with Giant Cell Arteritis. The headache was acute at onset and the stroke was in the anterior circulation, which is relatively uncommon. We need to consider the possibility of GCA, especially in this age group, and, after ruling out other possibilities, should not delay starting corticosteroids in these patients to avoid catastrophic consequences, including blindness.
 

Keywords: Giant cell arteritis, Stroke, Thunderclap headache

How to cite : Puri S, Aleena I, Chakraborty D, A story of thundeclap headache and stroke. IP Indian J Neurosci 2024;10(2):114-116

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