Prognostic Significance of Sentinel Headache Preceding Aneurysmal Subarachnoid Hemorrhage.
Adult
Aged
Brain Ischemia
/ etiology
Cerebral Angiography
Cerebrovascular Circulation
Female
Headache
/ diagnosis
Humans
Male
Middle Aged
Middle Cerebral Artery
/ diagnostic imaging
Prognosis
Recurrence
Retrospective Studies
Subarachnoid Hemorrhage
/ complications
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler, Transcranial
Vasospasm, Intracranial
/ etiology
Delayed cerebral ischemia
Intracranial aneurysm
Outcome
Rebleeding
Sentinel Headache
Subarachnoid Hemorrhage
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
13
02
2020
revised:
10
04
2020
accepted:
11
04
2020
pubmed:
28
4
2020
medline:
27
10
2020
entrez:
28
4
2020
Statut:
ppublish
Résumé
Sentinel headache (SH) is often assumed to portend an increased risk of delayed cerebral ischemia (DCI) and aneurysm rebleeding. This study aimed to re-evaluate the associations between SH and aneurysm rebleeding, DCI, and outcome after SAH. We retrospectively analyzed 1102 patients with spontaneous SAH and available data regarding history of SH who were enrolled in the Columbia University SAH Outcomes Project between 1996 and 2009. Patients were asked whether they had experienced any episodes of acute, sudden-onset severe headache in the 2 weeks preceding the most recent bleeding event. DCI was defined as neurologic deterioration, infarction, or both due to vasospasm. Rebleeding was defined as the appearance of new hemorrhage on computed tomography. Outcome was assessed at 3 months by telephone interview using the modified Rankin Scale. SH was reported in 152 (14%) of 1102 patients. There were no significant differences between patients with and without SH with regard to admission Hunt-Hess grade or modified Fisher Scale. There was also no difference with regard to the frequency of aneurysm rebleeding (10% vs. 8%, P = 0.42), DCI (18% vs, 20%, P = 0.64), moderate-or-severe angiographic vasospasm on follow-up angiography (51% vs. 56%, P = 0.43), highest recorded mean middle cerebral artery flow velocity on transcranial Doppler (134 versus 128 cm/s, P = 0.30), or the distribution of modified Rankin Scale scores at 3 months. A history of sentinel headache before the clinical diagnosis of SAH does not imply an increased risk of DCI or further rebleeding, and carries no prognostic significance.
Sections du résumé
BACKGROUND
Sentinel headache (SH) is often assumed to portend an increased risk of delayed cerebral ischemia (DCI) and aneurysm rebleeding. This study aimed to re-evaluate the associations between SH and aneurysm rebleeding, DCI, and outcome after SAH.
METHODS
We retrospectively analyzed 1102 patients with spontaneous SAH and available data regarding history of SH who were enrolled in the Columbia University SAH Outcomes Project between 1996 and 2009. Patients were asked whether they had experienced any episodes of acute, sudden-onset severe headache in the 2 weeks preceding the most recent bleeding event. DCI was defined as neurologic deterioration, infarction, or both due to vasospasm. Rebleeding was defined as the appearance of new hemorrhage on computed tomography. Outcome was assessed at 3 months by telephone interview using the modified Rankin Scale.
RESULTS
SH was reported in 152 (14%) of 1102 patients. There were no significant differences between patients with and without SH with regard to admission Hunt-Hess grade or modified Fisher Scale. There was also no difference with regard to the frequency of aneurysm rebleeding (10% vs. 8%, P = 0.42), DCI (18% vs, 20%, P = 0.64), moderate-or-severe angiographic vasospasm on follow-up angiography (51% vs. 56%, P = 0.43), highest recorded mean middle cerebral artery flow velocity on transcranial Doppler (134 versus 128 cm/s, P = 0.30), or the distribution of modified Rankin Scale scores at 3 months.
CONCLUSIONS
A history of sentinel headache before the clinical diagnosis of SAH does not imply an increased risk of DCI or further rebleeding, and carries no prognostic significance.
Identifiants
pubmed: 32339738
pii: S1878-8750(20)30804-4
doi: 10.1016/j.wneu.2020.04.097
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e672-e676Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.