Abstract

Thunderclap headache (TCH) is a syndrome of acute and severe headache that has maximal intensity straight from the beginning. It is often the first sign of life threatening neurovascular disorders such as subarachnoid haemorrhage, venous sinus thrombosis or cervical artery dissection. Ischaemic stroke is considered to be another, relatively infrequently noted reason for secondary TCH. We present a case of a 65-year-old woman without any known history of common vascular risk factors, whose cerebellar infarction manifested as TCH and systemic vertigo. Evident cerebellar ataxia emerged only with a delay of three days after the first symptoms. Computerised tomography angiography, performed with a delay of these three days, revealed an occlusion of the proximal portion of the left vertebral artery near the branching of a posterior inferior cerebellar artery. The case represents a rather rarely described but significant, “not-to-be-missed”, clinical situation. In all cases of TCH, an organic cause, especially of vascular origin, should be suspected, particularly if it is accompanied by any additional features, even it is only acute systemic vertigo without any other neurologic signs which can remain absent or emerge later.