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Episodic Unsteadiness and Blurred Vision after Hypertensive Crisis with Thunderclap Headache



Parallel abstracts

Hypertensive crisis (HC) seldom presents with simply a thunderclap headache (TCH). A 56-year-old male had been sent to our emergency department because of TCH. Physical examination, lumbar puncture cerebral-spinal fluid analysis, and computed tomography were normal; however, HC was identified. Henceforward, he presented frequent episodic unsteadiness and blurred vision every day for 6 months. Physical examination was normal, but positioning test and squat to standing test induced the same symptom. Electroencephalogram, 24 hours' Holter, electronystagmogram, caloric test and blood examination were unremarkable. Neck duplex scanning showed atherosclerosis of carotid arteries. Diffusion weighted image and apparent diffusion coefficient magnetic resonance image revealed lesion of midbrain superior colliculus. Time-of-flight magnetic resonance angiogram showed deficient branches of vertebrobasilar artery. His HC presented with simple TCH, a very rare curiosity. Although the causation between HC and TCH was yet uncertain, they were closely related. Bilateral midbrain superior colliculus were affected during the attack, and afterwards, unsteadiness and blurred vision were incurred by changing position. Thus, conservative treatment was recommended. Two months later, the symptom subsided. In the following half a year, there was no recurrence.