Nontraumatic Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) is defined as blood in the subarachnoid space. Nontraumatic SAH is most commonly caused by rupture of an aneurysm located at the circle of Willis. Patients often present with acute thunderclap headache but also may lose consciousness or have focal neurologic deficits. Detection of an aneurysm, if present, and its treatment are needed urgently to prevent recurrent bleeding. Patients with nontraumatic SAH are prone to numerous complications that require preventative measures, early recognition, and treatment.

Secondary Headache Disorders

In the evaluation of a patient with headache, the first task is to differentiate between a secondary headache and a primary headache. This step is essential because secondary causes of headache may require vastly different evaluation and treatment than primary headache disorders. Thunderclap headache (TCH) is an acute, severe headache with an abrupt onset, reaching maximum intensity in less than 1 minute. TCH is a neurologic emergency and should immediately prompt an urgent evaluation for a secondary headache.

Spontaninių subarachnoidinių hemoragijų literatūros apžvalga: rizikos veiksniai, diagnostikos ypatumai ir komplikacijos (I dalis)

Plyšusios galvos smegenų aneurizmos sukelta subarachnoidinė hemoragija (SAH) yra dažna vidutinio amžiaus žmonių neįgalumo ir mirties priežastis. SAH dažniau pasireiškia moterims nei vyrams, juodosios rasės asmenims ir daugiausia diagnozuojama Suomijoje ir Japonijoje. Riziką susirgti labai didina šeiminė SAH ir (ar) aneurizmų predispozicija. Tarp koreguojamų rizikos veiksnių reikšmingiausią poveikį turi rūkymas, arterinė hipertenzija ir piktnaudžiavimas alkoholiu. Klinikinėje praktikoje aneurizmos plyšimo rizikai vertinti yra įdiegta PHASES ir kitos skalės, apimančios svarbiausius įtaką darančius veiksnius. SAH reikšmingiausias klinikinis požymis yra staigus ir stiprus galvos skausmas, dar vadinamas žaibo kirčio galvos skausmu (angl. thunderclap headache). Taip pat gali būti stebimas sąmonės sutrikimas, traukuliai, galvinių nervų pažeidimas, galūnių nusilpimas, meninginiai simptomai. Galvos kompiuterinė tomografija (KT) ir (ar) juosmens punkcija yra pagrindiniai SAH diagnozę pagrindžiantys instrumentiniai tyrimai, o skaitmeninė subtrakcinė angiografija laikoma aukso standartu, diagnozuojant intrakranijines aneurizmas. Į praktiką įdiegiama vis daugiau diagnostikos priemonių, tokių kaip magnetinio rezonanso tomografija su GRE, SWI, FLAIR sekomis, kurios pranoksta KT jautrumu, specifiškumu, ypač pirmosiomis dienomis patyrus SAH. Mirštamumą itin didina dažnai pasitaikančios lokalios ir sisteminės komplikacijos: pakartotinis aneurizmos plyšimas, hidrocefalija, ūmūs traukuliai, kardiovaskulinės komplikacijos ir smegenų išemija, kurios dažniausia priežastis – vazospazmas.

HaNDL Syndrome Presenting with Thunderclap Headache

Introduction. Transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) is defined as a secondary, nonvascular headache disorder characterized by the findings described in its name. Patients with HaNDL syndrome typically present with gradual onset migrainous headaches of moderate to severe intensity with transient neurological symptoms. Case Report. We discuss a patient who presented with thunderclap headache, recent transient neurologic deficits, and was ultimately diagnosed with HaNDL after an extensive neurologic evaluation. Conclusion. Thunderclap headache has very rarely been described in patients with HaNDL. After excluding emergent and secondary causes, HaNDL should be considered in patients with thunderclap-quality headaches, particularly when there is a history of transient neurological symptoms.

Severe abrupt (thunderclap) non-traumatic headache at the pediatric emergency department – a retrospective study

Background Adult abrupt severe non-traumatic headache (thunderclap) is often related to serious underlying etiologies such as subarachnoid hemorrhage. However, data are sparse regarding thunderclap headache in the pediatric population. Objective The aim of the study was to evaluate the prevalence, characteristics and causes of thunderclap headache in the pediatric and adolescent population, aged 6–18 years, presenting to a pediatric emergency department. Methods The electronic database of a tertiary care pediatric emergency department was searched for children presenting with acute headache during 2016–2018. Headache severity was defined by pain scales, either a visual analogue scale or by the Faces Pain Scale–Revised. Results Thunderclap headache was diagnosed in 19/2290 (0.8%) of the included patients, all of them with a pain score of 10/10. All the patients had a benign course. Primary headache was diagnosed in 15/19 (78.9%), six patients had migraine and eight were diagnosed with primary thunderclap headache. Four of the 19 patients were diagnosed with secondary headache: three with infectious causes and one with malignant hypertension. Conclusions Thunderclap headache is rare among children and adolescents presenting to the emergency department. This headache is generally of a primary origin. Extensive evaluation is still needed to rule out severe diagnosis problems.