Rapid diagnosis vital in thunderclap headache.

Practitioner Pub Date : 2016-04-01
Andrew Barritt, Sarah Miller, Indran Davagnanam, Manjit Matharu
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引用次数: 0

Abstract

Thunderclap headache is a severe and acute headache that reaches maximum intensity in under one minute and lasts for more than five minutes. Subarachnoid haemorrhage (SAH) accounts for 10-25% of all thunderclap headaches and, despite advances in medical technology, has a 90-day mortality of 30%. Up to a quarter of cases of SAH are misdiagnosed, often through failure to follow guidance. Thunderclap headaches may be associated with symptoms such as photophobia, nausea, vomiting, neck pain, focal neurological symptoms or loss of consciousness. SAH is more likely if there are neurological abnormalities or reduced consciousness. Loss of consciousness at onset is a poor prognostic indicator with a 2.8-fold increase in risk of death. All patients with suspected SAH should undergo a non-contrast CT brain scan as soon as possible after the onset of pain as the sensitivity of CT drops with time. A negative CT is not sensitive enough to exclude SAH and must be followed with lumbar puncture at least 12 hours after onset of the headache. If SAH is excluded then further investigations, in particular MRI brain and vascular imaging with MRI or CT angiography, should be considered to exclude other aetiologies. Headaches, caused by cervical artery dissection are most commonly of gradual onset but up to 20% of patients complain of thunderclap headache.

快速诊断对雷击性头痛至关重要。
雷击头痛是一种严重的急性头痛,在一分钟内达到最大强度,持续五分钟以上。蛛网膜下腔出血(SAH)占所有雷击性头痛的10-25%,尽管医疗技术有所进步,但90天死亡率为30%。高达四分之一的SAH病例被误诊,通常是由于没有遵循指导。雷击性头痛可能伴有畏光、恶心、呕吐、颈部疼痛、局灶性神经症状或意识丧失等症状。如果有神经异常或意识下降,SAH更有可能发生。发病时意识丧失是一个不良的预后指标,死亡风险增加2.8倍。所有疑似SAH的患者在疼痛发作后应尽快行CT非对比扫描,因为CT的敏感性随着时间的推移而下降。CT阴性不足以排除SAH,必须在头痛发作后至少12小时进行腰椎穿刺。如果排除SAH,则进一步检查,特别是MRI脑和血管成像与MRI或CT血管造影,应考虑排除其他病因。由颈动脉剥离引起的头痛最常见的是逐渐发作,但高达20%的患者主诉为雷击头痛。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Practitioner
Practitioner Medicine-Family Practice
自引率
0.00%
发文量
1
期刊介绍: The term "practitioner" of course has general application. It is used in a wide variety of professional contexts and industry and service sectors. The Practioner.Com portal is intended to support professionals in a growing number of these. Across a range of sub-sites, we offer a raft of useful information and data on the core topic(s) covered. These range from Legal Practioner (legal profession) through ITIL Practitioner (IT Infrastructure Library), Information Security Practitioner, Insolvency Practitioner (IP), General Practitioner and beyond.
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