Introduction: Sub-arachnoid hemorrhage, cerebral venous thrombosis and cerebral reversible angiopathies are the main causes of secondary thunderclap headache. Ischemic stroke is rarely revealed by thunderclap headache.
Case report: A 80-year-old woman developed for the first time a thunderclap headache associated with transient distal motor deficit of the right hand. Diffusion-weighted sequences revealed a recent left infarct in a vascular border zone.
Conclusion: Ischemic stroke is a rare cause of thunderclap headache but practitioners should bear in mind this etiology when the diagnostic work-up is negative. Diffusion-weighted sequences of the brain MRI can provide the diagnosis.