Ljubisavljevic Srdjan, Milosevic Vuk, Stojanov Aleksandar, Ljubisavljevic Marina, Dunjic Olivera, Zivkovic Miroslava
Faculty of Medicine, University of Nis, Nis, Serbia; Clinic for Neurology, Clinical Center Nis, Nis, Serbia.
Clinic for Neurology, Clinical Center Nis, Nis, Serbia.
Clin Neurol Neurosurg. 2017 Jul;158:40-45. doi: 10.1016/j.clineuro.2017.04.017. Epub 2017 Apr 23.
Headache is recognized as the main but unwarranted symptom of subarachnoid hemorrhage (SAH). There are no enough findings identified as predictive for headache occurrence in SAH. We evaluated the clinical and paraclinical factors predictive for headache occurrence in SAH.
We retrospectively analyzed medical records of 431 consecutive non traumatic SAH patients (264 females and 167 males), ages from 19 to 91 years, presenting with headache (70.3%) and without headache (29.7%) during period of 11years.
Among all tested parameters, as negative predictors for headache occurrence were recognized: patients' ages (OR 0.97 [95%CI: 0.96-0.99], p=0.025), persistence of coagulation abnormality (OR 0.23 [95%CI: 0.08-0.67], p=0.006), atrial fibrilation (OR 0.23 [95%CI: 0.09-0.59], p=0.002), chronic renal failure (OR 0.26 [95%CI: 0.09-0.76], p=0.014) and more diseases (OR 0.11 [95%CI: 0.04-0.32], p<0.0001), as higher clinical score (OR 0.94 [95%CI: 0.90-0.99], p=0.018) including positive neurological findings (OR 0.34 [95%CI: 0.21-0.55], p<0.001) and loss of consciousness (OR 0.22 [95%CI: 0.12-0.39], p<0.001) at the SAH onset, while the complaint of neck stiffness was identified as its positive predictor (OR 1.93 [95%CI: 1.19-3.10], p=0.007).
Although diagnosis based solely on clinical presentation is not reliable and speculative, our findings could provide physicians with evidence to consider SAH not only in conditions of its headache occurrence but also in those with headache absence.
头痛被认为是蛛网膜下腔出血（SAH）的主要但无必要的症状。目前尚无足够的发现可被确定为SAH头痛发生的预测因素。我们评估了SAH头痛发生的临床和辅助临床预测因素。
我们回顾性分析了431例连续的非创伤性SAH患者（264例女性和167例男性）的病历，年龄在19至91岁之间，这些患者在11年期间出现头痛（70.3%）和未出现头痛（29.7%）。
在所有测试参数中，被认为是头痛发生的负性预测因素的有：患者年龄（OR 0.97 [95%CI：0.96 - 0.99]，p = 0.025）、凝血异常持续存在（OR 0.23 [95%CI：0.08 - 0.67]，p = 0.006）、心房颤动（OR 0.23 [95%CI：0.09 - 0.59]，p = 0.002）、慢性肾衰竭（OR 0.26 [95%CI：0.09 - 0.76]，p = 0.014）以及更多疾病（OR 0.11 [95%CI：0.04 - 0.32]，p < 0.0001）；而较高的临床评分（OR 0.94 [95%CI：0.90 - 0.99]，p = 0.018）包括SAH发作时的阳性神经系统体征（OR 0.34 [95%CI：0.21 - 0.55]，p < 0.001）和意识丧失（OR 0.22 [95%CI：0.12 - 0.39]，p < 0.001）被认为是头痛发生的负性预测因素，同时颈部僵硬主诉被确定为其阳性预测因素（OR 1.93 [95%CI：1.19 - 3.10]，p = 0.007）。
尽管仅基于临床表现的诊断不可靠且具有推测性，但我们的发现可为医生提供证据，不仅在有头痛发生的情况下考虑SAH，也在无头痛的情况下考虑SAH。
