A patient presented with thunder clap headache. Followed by unconsciousness with progressive 3"I cranial nerve palsy

Aneurysmal subarachnoid hemorrhage Thunderclap headache is an acute and severe headache that is maximum in intensity at onset and has been likened to a clap of thunder. The term TCH was initially used by Day and Raskin in reference to the pain associated with an unrupured intracranial aneurysm. However, multiple causes of Thunderclap headache have since been described. "Subarachnoid hemorrohage is the most common cause of thunderclap headaches". Primary Thunder Clap headache Primary TCH is diagnosed when all other potential underlying causes have been eliminated by diagnostic testing. Primary TCH's can recur intermittently and are generally associated with benign outcome. The. International Headache Society's distagnoic criteria for Primary TCH (A) Severe headpain fUlfilling criteria B and C (B) Both of the. following characteristics. - Sudden onset, - Reaching maximum intensity in < lmin lasting .from 1 hour to 10 days. (C) Does not recur regularly over subsequent weeks or months. (D) Not attributed to another disorder (normal cerebrospinal fluid and normal brain imaging are needed) Secondary causes of Thunderclap headache Subarachnoid hemorrhagedeg Sentinel headache Cerebral venous sinus thrornbosisQ Cervical aery dissection Spontaneous intracranial hypotension Pituitary apoplexyQ Retroclival hematoma lschaemic stroke Acute hypeensive crisis Reversible cerebral vasoconstriction syndrome Third ventricle colloid cyst Intracranial infection Primary thunderclap headache Primary cough, sexual and exeional headache