Ghossoub M, Nataf F, Merienne L, Devaux B, Turak B, Roux F X
Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris Cedex 14.
Neurochirurgie. 2001 May;47(2-3 Pt 2):177-83.
and purposes. The purpose of this study was to identify the specific characteristics of headaches associated with cerebral arteriovenous malformations in order to differentiate them from other known entities of headaches such as migraine, cluster headache, and trigeminal neuralgia. This differentiation allows an early diagnosis of cAVM and a treatment to be administrated before any cerebral hemorrhage.
The study included 700 patients with cAVM and treated by radiosurgery. Out of this series, only 109 (48 males, 61 females, mean age of 33) presented with headaches. Headaches were studied as a possible revelation mode of a cAVM, either as an isolated sign, preceding an epileptic seizure, a cerebral hemorrhage, or associated with a neurological deficit. Analysis concerned 13 clinical parameters and 30 anatomic parameters based on angiography.
Headaches were found in 15.6%; they were isolated in 6%. They preceded a cerebral hemorrhage in 12.6%, constituting an early alarm signal when increasing in intensity, frequency and duration. They were associated with seizures or a neurological deficit in 9.6%. We found a predominant female sex-ratio (0.78) and occurrence at a young age (72.3% between 10 and 40 years). Headaches were non-pulsating in 95.3%; nausea, vomiting, light or sound phobia were only found in 4.7%. Headaches were unilateral and homolateral to the malformation in 80%, corresponding to the malformation topography in 97.4% in posterior location and 80% in anterior location. Associated neurological symptoms existed in 20.2%; related to the malformation and lasting 5 to 30 minutes. Duration of pain episodes was less than 3 hours in 77% with a frequency of 1 to 2 per month in 82.5%. Pain was mild and responded to simple analgesics. A family migraine was found in only 3 patients. The angiographic characteristics of the malformations were meningeal afferences, superficial venous drainage and posterior location.
Headaches associated with cerebral arterio-venous malformations form a distinct category that can be determined from specific characteristics; this should help an early diagnosis of cerebral arterio-venous malformations in order to start a treatment before the occurrence of cerebral hemorrhage.
背景与目的。本研究旨在确定与脑动静脉畸形相关的头痛的具体特征，以便将其与偏头痛、丛集性头痛和三叉神经痛等其他已知头痛类型区分开来。这种区分有助于早期诊断脑动静脉畸形，并在发生任何脑出血之前进行治疗。
患者与方法。该研究纳入了700例接受放射外科治疗的脑动静脉畸形患者。在这一系列患者中，只有109例（48例男性，61例女性，平均年龄33岁）出现头痛。头痛被作为脑动静脉畸形的一种可能的首发表现形式进行研究，无论是作为孤立症状、先于癫痫发作、脑出血出现，还是与神经功能缺损相关。分析基于血管造影涉及13项临床参数和30项解剖参数。
结果。发现15.6%的患者有头痛症状；其中6%为孤立性头痛。12.6%的头痛先于脑出血出现，当强度、频率和持续时间增加时构成早期警报信号。9.6%的头痛与癫痫发作或神经功能缺损相关。我们发现女性比例占主导（0.78），且发病年龄较轻（72.3%在10至40岁之间）。95.3%的头痛无搏动性；仅4.7%的患者有恶心、呕吐、畏光或畏声症状。80%的头痛为单侧且与畸形同侧，在后颅窝病变中97.4%与畸形部位对应，在前颅窝病变中80%与畸形部位对应。20.2%的患者存在相关神经症状；与畸形相关且持续5至30分钟。77%的疼痛发作持续时间少于3小时，82.5%的患者发作频率为每月1至2次。疼痛程度较轻，对简单镇痛药有反应。仅3例患者有家族性偏头痛病史。畸形的血管造影特征为脑膜供血、浅表静脉引流和后颅窝病变。
与脑动静脉畸形相关的头痛构成一个独特类别，可根据特定特征确定；这应有助于早期诊断脑动静脉畸形，以便在脑出血发生前开始治疗。
