Headache: an unusual presentation of aortic dissection

Singh, Sukhvinder; Huang, J.; Charles, R

doi:10.1097/01.mej.0000224435.89740.bc

Cited by 14 publications

(10 citation statements)

References 8 publications

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“…Ischaemic stroke is due to thromboemboli from the dissected vessel or occlusion of cervical arteries branching from the dissected aortic arch. There are four previously reported cases of headache, all of which were frontal, but there are no reports of occipital headache (as in our patient) as the presenting feature of aortic dissection 3 4 5 6. Two of those were in known migraineurs but our patient did not have migraine.…”

Section: Final Commentcontrasting

confidence: 45%

Thunderclap headache

2009

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Section: Final Commentcontrasting

confidence: 45%

Thunderclap headache

2009

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“…By their nature, case reports will focus on the esoteric or unusual, but our review has highlighted some important associations including systemic conditions like Aortic Dissection [ 233 , 234 , 279 , 280 ], Cardiac Cephalalgia [ 26 , 227 - 229 , 231 , 232 , 281 - 283 ], Phaeochromocytoma [ 236 , 237 ], serious infections like Dengue Haemorrhagic Fever [ 74 ] and Q-Fever [ 72 ], as well as Erve Virus [ 68 , 71 ]. Rare vasculopathies such as Vogt-Kayanagi-Harada Disease [ 121 , 122 ], or cerebral vasculitis [ 119 ] do appear on the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?

2014

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BackgroundThere are many potential causes of sudden and severe headache (thunderclap headache), the most important of which is aneurysmal subarachnoid haemorrhage. Published academic reviews report a wide range of causes. We sought to create a definitive list of causes, other than aneurysmal subarachnoid haemorrhage, using a systematic review.MethodsSystematic Review of EMBASE and MEDLINE databases using pre-defined search criteria up to September 2009. We extracted data from any original research paper or case report describing a case of someone presenting with a sudden and severe headache, and summarized the published causes.ResultsOur search identified over 21,000 titles, of which 1224 articles were scrutinized in full. 213 articles described 2345 people with sudden and severe headache, and we identified 6 English language academic review articles. A total of 119 causes were identified, of which 46 (38%) were not mentioned in published academic review articles. Using capture-recapture analysis, we estimate that our search was 98% complete. There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. In cohort studies, the most common causes identified were primary headaches or headaches of uncertain cause. Vasoconstriction syndromes are commonly mentioned in case reports or case series. The most common cause not mentioned in academic reviews was pneumocephalus. 70 non-English language articles were identified but these did not contain additional causes.ConclusionsThere are over 100 different published causes of sudden and severe headache, other than aneurysmal subarachnoid haemorrhage. We have now made a definitive list of causes for future reference which we intend to maintain. There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral vasoconstriction syndromes.

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“…Approximately half of all patients who did not report pain showed neurological symptoms only [5]. However, aortic dissection may also present with misleading signs of subarachnoid hemorrhage like major pain in the head or in the neck [5, 10,23,24,25,26]. Therefore, neurologists and internal specialists must be vigilant for aortic dissection in patients with atypical pain and/or pure neurological symptoms.…”

Section: Atypical Presentation Of Aortic Dissectionsmentioning

confidence: 99%

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

2008

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Typically, aortic dissection has to be considered in patients with acute thoracic or abdominal pain and accompanying cardiovascular symptoms. Due to these clinical symptoms, neurologists have not been involved in the routine emergency management of aortic dissection. However, transient or permanent neurological symptoms at onset of aortic dissection are not only frequent (17–40% of the patients), but often dramatic and may mask the underlying condition. Especially in pain-free dissection (which occurs in 5–15%) with predominant neurological symptoms diagnosis of aortic dissection can be difficult and delayed. Affecting the outflow of supra-aortal, spinal as well as extremity arteries leads to a variety of neurological symptoms including disturbances of central or peripheral nervous system. Thrombolysis as an emergency stroke therapy without considering aortic dissection may be life-threatening for these patients. Routine chest X-ray and being alert to physical examination findings such as hypotension, asymmetrical pulses or cardiac murmur may reduce risk of delayed diagnosis or misdiagnosis. Neurological symptoms at onset or in the postoperative course of aortic dissection are not necessarily associated with increased mortality.

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Headache: an unusual presentation of aortic dissection

Cited by 14 publications

References 8 publications

Thunderclap headache

Thunderclap headache

A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

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