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

Year 2021, Volume: 6 Issue: 1, 7 - 12, 01.04.2021

Aynur Yurtseven , Yahya Güvenç

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

References

• 1. Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3):193-210.
• 2. Ramirez-Lassepas M, Espinosa CE, Cicero JJ, Johnston KL, Cipolle RJ, Barber DL. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol 1997;54:1506-9.
• 3. Goldstein JN, Camargo CA Jr, Pelletier AJ, Edlow JA. Headache in United States emergency departments: demographics, work-up and frequency of pathological diagnoses. Cephalalgia 2006;26(6):684–90.
• 4. Bigal M, Bordini CA, Speciali JG. Headache in an emergency room in Brazil. Sao Paulo Med J 2000;118(3):58–62.
• 5. Luda E, Comitangelo R, Sicuro L. The symptom of headache in emergency departments. The experience of a neurology emergency department. Ital J Neurol Sci 1995;16(5):295–301.
• 6. Headache Classification Committee of the International Headache Society (IHS) , The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia 2013;33(9) 629–808.
• 7. Linet MS, Stewart WF, Celentano DD, Ziegler D, Sprecher M. An epidemiologic study of headache among adolescents and young adults. JAMA 1989;261:2211-6.
• 8. Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms A prospective randomized study. Stroke. 2000;31:2369–77.
• 9. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the Interna tional Headache Society. Cephalalgia 1988;8 (suppl 7):1-96.
• 10. Morgenstern LB, Luna-Gonzalez H, Huber JC, et al. Worst headache and subarachnoid hemorrhage: prospec- tive, modern computed tomography and spinal fluid analysis. Ann Emerg Med 1998;32(3 pt 1): 297-304.
• 11. Evans RW. Diagnostic testing for the evaluation of headaches. Neurol Clin 1996;14:1-26.
• 12. J. A. Edlow and L. R. Caplan, “Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage,” The New England Journal of Medicine, vol. 342, no. 1, pp. 29–36, 2000.
• 13. Edlon JA, Caplan LR. Avoiding pittfalls in the diagnosis of subarachnoid hemorrhage. N Eng J Med 2000:342:29-36.
• 14. Rothman RE, Keyl PM, McArthur JC, Beauchamp NJ Jr, Danyluk T, Kelen GD. A decision guideline for emergency department utilization of non- contrast head computed tomography in HIV-infected patients. Acad Emerg Med. 1999;6(10):1010-1019.
• 15. McDonald RL, Weir B: Perioperatine Management of Subarachnoid Hemorrhage. Youmans Fifth edition, Vol II, Philadelphia, Elsevier 1996; 1813-38.
• 16. (15) Schull MJ. Headache and facial pain. In: Tintinalli JE, Kelen GD, Stapczynski JS, editors. Emergency medicine: a compre-hensive study guide. Toronto (ON): McGraw–Hill; 2000:1422-302.
• 17. van der Wee N, Rinkel GJE, Hasan D, van Gijn J. Detection of subarachnoid haemorrhage on early CT: Is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry 1995;58:357-9.
• 18. Vazquez-Barquero A, lbanes FJ, Herrera S, Izquierdo JM, Berciano J, Pas- cual J. Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalalgia 1994; 14:270-272.
• 19. Frishberg BM. The utility of neuroimaging in the evaluation of headache in patients with normal neurologic examinations. Neurology 1994; 44:1191-1197.
• 20. Yo-El S. Ju and Todd J. Schwedt , Abrupt-Onset Severe Headaches Semin Neurol . 2010 April ;30(2): 192–200.
• 21. Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 1966;25:219–239.
• 22. Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg 1966;25:321–368.
• 23. Pakarinen S. Incidence, aetiology, and prognosis of primary subarachnoid haemorrhage. A study based on 589 cases diagnosed in a defined urban popu-lation during a defined period. Acta Neurol Scand 1967;43(Suppl 29):1–28.