Cause | Clinical features | Brain CT | Lumbar puncture | Angiography | Brain MRI |
Aneurysmal subarachnoid hemorrhage | Altered consciousness, seizures, meningismus | Subarachnoid blood in basilar cisterns and sylvian fissures | Elevated red blood cells, xanthochromia | Ruptured aneurysm, vasospasm | Subarachnoid blood in basilar cisterns and sylvian fissures |
Reversible cerebral vasoconstriction syndrome | Recurrent thunderclap headaches | Normal, or subarachnoid blood along cortical surface/sulci | Normal, mild white blood cell elevation, mild protein elevation | Multifocal multivessel vasoconstriction | Normal, or subarachnoid blood along cortical surface/sulci, ischemic stroke, cerebral edema, intracerebral hemorrhage |
Carotid and vertebral artery dissection | Neck pain, symptoms related to cerebral ischemia, Horner syndrome (carotid dissection) | Normal, or ischemic stroke | Normal | Dissected artery, multifocal, segmental vasoconstriction if associated with reversible cerebral vasoconstriction syndrome | Normal, or ischemic stroke |
Cerebral venous sinus thrombosis | Focal neurologic deficits, altered mental status, visual changes | Dense triangle sign (clot inside the sinus), cord sign (thrombosed cortical or deep vein), venous hemorrhages | Elevated opening pressure, high protein | Venous sinus thrombosis | Normal, or venous infarctions with hemorrhage; MRI evidence of intraluminal thrombus on T1, T2, and susceptibility-weighted imaging sequences |
Spontaneous intracranial hypotension | Orthostatic headache, auditory muffling | Normal, or subdural collections | Low opening pressure | Normal | Pachymeningeal enhancement, sagging brain, subdural collections |
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