Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
World Neurosurg. 2020 Jul;139:e672-e676. doi: 10.1016/j.wneu.2020.04.097. Epub 2020 Apr 24.
Sentinel headache (SH) is often assumed to portend an increased risk of delayed cerebral ischemia (DCI) and aneurysm rebleeding. This study aimed to re-evaluate the associations between SH and aneurysm rebleeding, DCI, and outcome after SAH.
We retrospectively analyzed 1102 patients with spontaneous SAH and available data regarding history of SH who were enrolled in the Columbia University SAH Outcomes Project between 1996 and 2009. Patients were asked whether they had experienced any episodes of acute, sudden-onset severe headache in the 2 weeks preceding the most recent bleeding event. DCI was defined as neurologic deterioration, infarction, or both due to vasospasm. Rebleeding was defined as the appearance of new hemorrhage on computed tomography. Outcome was assessed at 3 months by telephone interview using the modified Rankin Scale.
SH was reported in 152 (14%) of 1102 patients. There were no significant differences between patients with and without SH with regard to admission Hunt-Hess grade or modified Fisher Scale. There was also no difference with regard to the frequency of aneurysm rebleeding (10% vs. 8%, P = 0.42), DCI (18% vs, 20%, P = 0.64), moderate-or-severe angiographic vasospasm on follow-up angiography (51% vs. 56%, P = 0.43), highest recorded mean middle cerebral artery flow velocity on transcranial Doppler (134 versus 128 cm/s, P = 0.30), or the distribution of modified Rankin Scale scores at 3 months.
A history of sentinel headache before the clinical diagnosis of SAH does not imply an increased risk of DCI or further rebleeding, and carries no prognostic significance.
先兆性头痛（SH）常被认为预示着迟发性脑缺血（DCI）和动脉瘤再出血的风险增加。本研究旨在重新评估 SH 与动脉瘤再出血、DCI 和蛛网膜下腔出血（SAH）后结局之间的关系。
我们回顾性分析了 1996 年至 2009 年期间在哥伦比亚大学 SAH 结局项目中入组的 1102 例自发性 SAH 患者，并对其 SH 病史相关数据进行了分析。患者被问及在最近出血事件前 2 周内是否经历过任何急性、突发性剧烈头痛发作。DCI 定义为血管痉挛引起的神经功能恶化、梗死或两者兼有。再出血定义为 CT 上出现新的出血。结局通过电话访谈在 3 个月时采用改良 Rankin 量表进行评估。
在 1102 例患者中，有 152 例（14%）报告了 SH。有 SH 病史和无 SH 病史的患者在入院时的 Hunt-Hess 分级或改良 Fisher 分级方面无显著差异。动脉瘤再出血的频率也无差异（10%比 8%，P=0.42），DCI 的发生率（18%比 20%，P=0.64），随访血管造影时中度或重度血管痉挛的发生率（51%比 56%，P=0.43），经颅多普勒记录的最高平均大脑中动脉血流速度（134 比 128cm/s，P=0.30），或 3 个月时改良 Rankin 量表评分的分布。
在 SAH 临床诊断之前出现先兆性头痛并不意味着 DCI 或进一步再出血的风险增加，也无预后意义。
