American Board of Internal Medicine (ABIM) Certification Practice Exam

In the evaluation of thunderclap headache, what imaging may be required if CT scans are normal?

1. Ultrasound of the neck

2. Pet scan

3. Lumbar puncture

4. Neurovascular imaging

The correct answer is: Neurovascular imaging

In cases of thunderclap headache, especially when a CT scan does not reveal any abnormalities, neurovascular imaging becomes crucial to identify potential causes such as cerebral venous sinus thrombosis or vascular malformations. Neurovascular imaging techniques, such as magnetic resonance angiography (MRA) or computed tomography angiography (CTA), allow for detailed visualization of the blood vessels in the brain and can help detect conditions that may not be visible on a standard CT scan. Thunderclap headaches can be indicative of serious underlying conditions like subarachnoid hemorrhage or other vascular issues, and when initial imaging yields normal results, further assessment through neurovascular imaging can provide essential information. It plays a vital role in ruling out significant vascular concerns in patients who present with sudden, severe headache symptoms.