Ljubisavljevic Srdjan, Ignjatovic Aleksandra, Ljubisavljevic Marina
Faculty of Medicine, University of Nis, Nis, Serbia.
Clinic for Neurology, Clinical Center Nis, Nis, Serbia.
Arch Med Sci. 2019 Dec 4;19(4):1028-1036. doi: 10.5114/aoms.2019.90356. eCollection 2023.
The predictive accuracy of clinical and paraclinical findings for headache occurrence in patients having nontraumatic intracerebral hemorrhage (ICH) was tested.
The medical records of 341 consecutive nontraumatic ICH patients (106 females and 235 males), average age 56.2 ±7.7 years, presenting with headache (25.5%) and without a headache (74.5%), over a period of 5 years, were retrospectively analyzed.
The presence of focal neurological symptoms (OR = 0.129, 95% CI: 0.044-0.372, = 0.000), loss of consciousness (OR = 0.174, 95% CI: 0.060-0.504, = 0.001), body temperature (OR = 0.586, 95% CI: 0.389-0.882, = 0.010), and the values of C-reactive protein (OR = 0.989, 95% CI: 0.978-0.999, = 0.048) at admission, as well as the presence of hematoma in the basal ganglia (OR = 0.308, 95% CI: 0.159-0.596, = 0.000) and the presence of arterial hypertension in the medical history (OR = 0.478, 95% CI: 0.230-0.991, = 0.047), are recognized as negative predictors for headache occurrence in ICH. The regular use of antihypertensive therapy is a prominent positive predictor for headache occurrence in ICH (OR = 1.906, 95% CI: 1.075-3.381, = 0.027). Patients presenting with headache had a favorable clinical outcome compared to those without headache in ICH presentation ( < 0.001).
The present results might be clinically useful for considering further diagnostic and therapeutic procedures as early as possible in patients with symptoms clinically suggestive of ICH, with and without headache in ICH clinical presentation. These data require confirmation in a prospective large-scale study.
对非创伤性脑出血(ICH)患者头痛发生的临床及辅助检查结果的预测准确性进行了测试。
回顾性分析了连续5年中341例非创伤性ICH患者(106例女性和235例男性)的病历,平均年龄56.2±7.7岁,其中有头痛症状的患者占25.5%,无头痛症状的患者占74.5%。
局灶性神经症状的出现(比值比[OR]=0.129,95%置信区间[CI]:0.044 - 0.372,P = 0.000)、意识丧失(OR = 0.174,95% CI:0.060 - 0.504,P = 0.001)、体温(OR = 0.586,95% CI:0.389 - 0.882,P = 0.010)、入院时C反应蛋白的值(OR = 0.989,95% CI:0.978 - 0.999,P = 0.048),以及基底节区血肿的存在(OR = 0.308,95% CI:0.159 - 0.596,P = 0.000)和病史中存在动脉高血压(OR = 于ICH患者头痛发生的阴性预测因素。规律使用抗高血压治疗是ICH患者头痛发生的显著阳性预测因素(OR = 1.906,95% CI:1.075 - 3.381,P = 0.027)。与ICH发作时无头痛的患者相比,有头痛症状的患者临床结局较好(P < 0.001)。
目前的结果对于尽早考虑对临床提示ICH的患者进行进一步诊断和治疗程序可能具有临床实用性,无论ICH临床表现中有无头痛症状。这些数据需要在前瞻性大规模研究中得到证实。