脑血管病的主要症状:头痛如何?

Leading symptoms in cerebrovascular diseases: what about headache?

机构信息

Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy.

Department of Neurology and Stroke Unit, Niguarda Ca' Granda Hospital, Milan, Italy.

出版信息

Neurol Sci. 2019 May;40(Suppl 1):147-152. doi: 10.1007/s10072-019-03793-8.

Abstract

Headache is a milestone in cerebrovascular disorders; indeed, it may represent the only symptom at onset or predominates over the other neurological features. Unfortunately, headache associated with cerebrovascular diseases lacks clear-cut characteristics as it may resemble a migraine attack, tension-type headache, or cluster headache; pain localization is also misleading along with drug (analgesic) response. However, in this review, we have analyzed and described the most common patterns of headache for different vascular disorders: it is known that headache due to subarachnoid aneurysmal hemorrhage presents peculiar characteristics (thunderclap, acute presentation, and high intensity), whereas in cerebral vasoconstriction syndrome, the short duration and the relapsing-remitting course of the thunderclap headache are key points for the diagnosis; in cervicocerebral artery, dissection pain is most commonly ipsilateral to the dissected vessel and is mainly perceived in the temporal area in case of carotid artery dissection and in the occipital area in case of vertebral artery dissection; in cerebral venous thrombosis, pain is often acute or subacute and severe; unfortunately, it may resemble a typical migraine attack or a tension-type episode; by the contrary, in primary angiitis of the central nervous system, pain is always subacute or chronic with mild-to-moderate intensity; finally, in brain arteriovenous shunts such as malformation or fistula, pain is more frequently a clue for disease complication such as hemorrhage from the malformation or thrombosis of the draining vein.

摘要

头痛是脑血管疾病的一个里程碑;事实上,它可能是发病时唯一的症状,或者比其他神经症状更为突出。不幸的是,与脑血管疾病相关的头痛缺乏明显的特征,因为它可能类似于偏头痛发作、紧张型头痛或丛集性头痛;疼痛的定位也具有误导性,同时药物(止痛药)反应也会受到影响。然而,在这篇综述中,我们分析并描述了不同血管疾病常见的头痛模式:众所周知,蛛网膜下腔出血引起的头痛具有特殊的特征(霹雳样头痛、急性发作和高强度),而在脑血管收缩综合征中,霹雳样头痛的短暂持续时间和反复发作过程是诊断的关键;在颈内动脉疾病中,疼痛通常发生在被撕裂血管的同侧,颈内动脉撕裂时主要在颞区感觉到,而椎动脉撕裂时则在枕区感觉到;在脑静脉血栓形成中,疼痛通常是急性或亚急性的,且严重;不幸的是,它可能类似于典型的偏头痛发作或紧张型发作;相反,在中枢神经系统原发性血管炎中,疼痛始终是亚急性或慢性的,强度为轻到中度;最后,在脑动静脉分流畸形或瘘管等疾病中,疼痛更多地是疾病并发症的线索,如畸形出血或引流静脉血栓形成。

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