Department of Neurology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
Cephalalgia. 2012 Oct;32(13):972-8. doi: 10.1177/0333102412455706. Epub 2012 Aug 8.
The study objective was to analyze cases of sudden death that presented to the National Deptartment of Clinical Neurosciences, Ireland, over a 10-year period (1997-2006) where headache was the presenting symptom.
Headache is a common yet challenging presentation in clinical neurology. In the vast majority of cases, the cause is trivial and reversible-however, in a few patients it may be indicative of a more sinister intracranial process. Recognizing associated "red flag" features and identifying possible life-threatening causes are crucial in ensuring prompt and appropriate intervention.
DESIGN/METHODS: A retrospective study/database of all autopsy cases presenting to the Neuropathology Department in Beaumont Hospital, Dublin, was carried out for the period 1997-2006. Cases were selected with headache as the presenting clinical feature. Traumatic head injuries or known central nervous system (CNS) disorders were excluded. Autopsy and medical reports were reviewed to identify associated red flag features at initial presentation according to the International Classification of Headache Diseases, second edition (ICHD-II) criteria.
Fifty-five autopsy cases out of a total of 499 complying with selection criteria were reviewed. Over the 10-year-study period, the number of cases of fatal headaches over time were negatively correlated. The most commonly associated red flag symptoms included age over 50: loss of consciousness and collapse, and worst/thunderclap character of headache. Cause of death at autopsy comprised vascular events 60.4% (N = 29), primary brain tumours/cysts 16.7% (N = 8) and meningitis 6.25% (N = 3). Aneurysms accounted for the majority of vascular cases 22.9% (N = 11), with loss of consciousness, occipital headache, neck pain and a focal neurological deficit seen more commonly in this subset of cases.
Sudden-onset headache is a common and often alarming presentation. The majority of cases are of a benign nature; however, a small proportion may be indicative of a catastrophic etiology. Documenting "red flags" on initial presentation is crucial to acutely identify and treat those at highest risk. The results demonstrate an improving trend among clinicians in recognizing and initiating appropriate interventions in these patients, and highlights particular red flag features common in cases of fatal headaches.
本研究旨在分析 1997 年至 2006 年期间爱尔兰国家临床神经科学系收治的以头痛为首发症状的猝死病例。
头痛是临床神经病学中常见但具有挑战性的表现。在绝大多数情况下，头痛的病因微不足道且可逆转；然而，在少数患者中，头痛可能提示更严重的颅内病变。识别相关的“危险信号”特征并确定可能危及生命的病因对于确保及时、恰当的干预至关重要。
方法/设计：对都柏林 Beaumont 医院神经病理学系 1997 年至 2006 年的所有尸检病例进行回顾性研究/数据库分析，选择以头痛为首发临床特征的病例。排除创伤性头部损伤或已知的中枢神经系统（CNS）疾病。根据国际头痛疾病分类，第二版（ICHD-II）标准，审查尸检和医疗报告，以确定初始表现时的相关“危险信号”特征。
在符合选择标准的 499 例尸检病例中，有 55 例被回顾。在 10 年的研究期间，致命性头痛病例的数量随时间呈负相关。最常见的相关“危险信号”症状包括年龄大于 50 岁、意识丧失和昏迷、头痛最严重/如霹雳。尸检结果显示，死因包括血管事件 60.4%（29 例）、原发性脑肿瘤/囊肿 16.7%（8 例）和脑膜炎 6.25%（3 例）。血管病例中动脉瘤占大多数 22.9%（11 例），这组病例中更常见意识丧失、枕部头痛、颈部疼痛和局灶性神经功能缺损。
突发性头痛是一种常见且常令人警惕的表现。大多数病例性质良性；然而，少数病例可能提示灾难性病因。在初始表现时记录“危险信号”对于急性识别和治疗高危患者至关重要。结果表明，临床医生在识别和启动这些患者的适当干预方面的意识不断提高，并突出了致命性头痛病例中常见的特定“危险信号”特征。
