Acute Severe Headache as The Sole Symptom of Early Spontaneous Subarachnoid Hemorrhage: A retrospective Study

Abstract

Objective: The aim of this study was to emphasize that life-threatening subarachnoid hemorrhage (SAH) can be present in patients who
present with headache and have normal neurological findings, to identify these patients at an early stage, and to contribute to decreased
morbidity and mortality by increasing the number of patients who are treated.
Methods: A total of 18362 patients who presented to our emergency department (ED) between January 2012 and December 2013 with
headache that had emerged within the past 24 hours and had normal neurological findings were included in the study. This was a retrospective study. The severity of the pain was queried during the examination and graded and recorded according to the visual analogue scale
(VAS). A total of 1424 patients with a VAS score ≥7 where we considered a secondary headache underwent cranial computed tomography
(CT).
Findings and Results: SAH incidence in patients presenting to the emergency service with acute headache was 0.04% (n=8). Other pathologies were CVO at 0.27% (n=57), intraparenchymal hemorrhage at 0.09% (n=18), subdural hematoma at 0.03% (n=5), and intracranial mass
at 0.06% (n=12).
Conclusion: Patients presenting to the emergency service with acute headache should be examined carefully. There can be a serious underlying pathology such as SAH even when the neurological examination is normal and headache is the only symptom. Early diagnosis and
treatment can prevent these with diseases with high morbidity and mortality

Keywords

• Headache
• subarachnoid hemorrhage
• early symptom
• retrospective

Spontan Subaraknoid Kanamanın Erken Dönem Tek Semptomu Olarak Akut Şiddetli Baş Ağrısı: Bir Retrospektif Çalışma

Abstract

Amaç: Bu çalışmanın amacı; sadece baş ağrısı şikayeti ile başvuran ve nörolojik muayenesi normal olup hayati tehlike teşkil eden subaraknoid kanamalı hastaları erken dönemde tanımlayıp tedavi başlayarak morbidite ve mortaliteyi azaltmaktır. Metod: Bu çalışmaya Ocak 2012 ve Aralık 2013 tarihleri arasında acil servisimize son 24 saat içerinde akut başlayan başağrısıyla başvuran ve normal nörolojik muayenesi olan 18362 hasta dahil edilmiştir. Çalışmamız retrospektif bir çalışmadır. Ağrının şiddeti visual analog scala (VAS) ya göre hastalar acil servise başvurduklarında yapılmıştır. VAS skoru ≥7 üstünde olan 1424 hasta sekonder baş ağrısı olarak değerlendirilip ve bu hastalara kranial tomografi çekildi. Sonuçlar: Akut baş ağrısıyla acil servise başvuran hastalarda subaraknoid kanama insidansı 0.04% (n=8). Diğer patolojiler SVO 0.27% (n=57), intraparankimal hemoraji 0.09% (n=18), subdural kanama 0.03% (n=5), intrakranial kitle 0.06% (n=12) olarak görülmüştür. Tartışma: Akut başağrısı tanısıyla acil servise başvuran hastalar dikkatli bir şekilde incelenmelidir. Hastada baş ağrısı tek semptom ve nörolojik muayene normal olmasına rağmen SAK gibi altta yatan ciddi patolojiler olabilir. Erken tanı ile morbidite ve mortalitesi yüksek olan bu hastalıkların önüne erken teşhis ve tedavi ile geçilebilir.

Keywords

• baş ağrısı
• subaraknoid kanama
• erken semptom

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