Takeuchi T, Kasahara E, Iwasaki M, Higuchi M, Kojima S
Department of Neurosurgery, Municipal Higashimatsuyama Hospital.
No Shinkei Geka. 1994 Oct;22(10):925-31.
The necessity of cerebral angiography was assessed in patients with thunderclap headache in whom subarachnoid hemorrhage had been ruled out on CT findings and the color of cerebrospinal fluid (CSF).
The subjects of this study were 350 patients with thunderclap headache in whom subarachnoid hemorrhage was ruled out at our clinic based on CT findings and the color of CSF. The time span from the onset of thunderclap headache to the first visit to our clinic ranged from 1 to 9 days (mean: 2.5 days). The ages of the patients ranged from 22 to 64 years. 147 were male and 203 female. All patients underwent CT angiography. Percutaneous cerebral angiography was also performed in cases in which cerebral aneurysms were suspected on CT angiography or the CSF cell count was elevated (over 10/3mm3 on white blood cells).
(1) Of the 350 patients, 162 were suspected to have cerebral aneurysms when examined by CT angiography. When these 162 patients were examined by percutaneous cerebral angiography, cerebral aneurysms were found in 34 patients (9.7%). (2) Four patients had an elevated CSF cell count. Cerebral aneurysms were found in all these patients. (3) Of the 34 patients with cerebral aneurysms, 31 consented to and underwent direct surgery. Localized subarachnoid hemorrhage around their aneurysms was found in seven (22.6%) of these 31 patients intraoperatively. Elevation in CSF cell count was shown in three of these patients.
Even when CT and CSF studies reveal no abnormalities in the early stage after the onset of thunderclap headache, subarachnoid hemorrhage can not be ruled out. Therefore, cerebral angiography is recommended in patients with thunderclap headache.
对于经CT检查结果及脑脊液颜色排除蛛网膜下腔出血的霹雳样头痛患者，评估其进行脑血管造影的必要性。
本研究对象为350例霹雳样头痛患者，这些患者在我院根据CT检查结果及脑脊液颜色被排除蛛网膜下腔出血。从霹雳样头痛发作至首次就诊于我院的时间跨度为1至9天（平均：2.5天）。患者年龄在22至64岁之间。男性147例，女性203例。所有患者均接受了CT血管造影。对于CT血管造影怀疑有脑动脉瘤或脑脊液细胞计数升高（白细胞超过10/3mm³）的病例，还进行了经皮脑血管造影。
（1）350例患者中，CT血管造影检查时162例怀疑有脑动脉瘤。对这162例患者进行经皮脑血管造影检查时，发现34例（9.7%）有脑动脉瘤。（2）4例患者脑脊液细胞计数升高。所有这些患者均发现有脑动脉瘤。（3）34例有脑动脉瘤的患者中，31例同意并接受了直接手术。术中在这31例患者中的七例（22.6%）发现其动脉瘤周围有局限性蛛网膜下腔出血。其中三例患者脑脊液细胞计数升高。
即使霹雳样头痛发作后早期CT和脑脊液检查未发现异常，也不能排除蛛网膜下腔出血。因此，推荐对霹雳样头痛患者进行脑血管造影。
