Leading symptoms in cerebrovascular diseases: what about headache?

Diamanti, Susanna; Longoni, Marco; Agostoni, Elio

doi:10.1007/s10072-019-03793-8

Cited by 23 publications

(23 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Headache of the thunderclap variety is extremely rare in PACNS, thus helping in distinguishing it from other neurological conditions that can mimic its clinical picture, such as subarachnoid hemorrhage or reversible cerebral vasoconstriction syndrome. It lacks however clear-cut characteristics [62] and should point to vasculitis; when it is associated with the imaging markers, we have selected based on our review and proposed with our algorithm.…”

Section: Discussionmentioning

confidence: 99%

“When should primary angiitis of the central nervous system (PACNS) be suspected?”: literature review and proposal of a preliminary screening algorithm

et al. 2020

View full text Add to dashboard Cite

Background Primary angiitis of the CNS (PACNS) is a process causing variously combined neurological disturbances. Its rarity and kaleidoscopic presentation make it difficult to diagnose and even to suspect. Objective (1) To provide an up-to-date review on PACNS and (2) to create a preliminary screening algorithm based on clinical and radiological first-level data, useful to suspect PACNS and guide further investigations. Methods Review of PUBMED case series on PACNS, published from 2002 to 2017, collection of frequencies of clinical and neuroimaging features and calculation of median values. Classification of features as “major” or “minor” if frequency was higher or lower than median value. Combination of features in sets of criteria represented by all possible combinations of major and minor clinical and neuroradiological features. Application of criteria to published PACNS case reports and selection of the ones best identifying patients with definite PACNS. Results We reviewed 24 case series. “Major” clinical features were headache, stroke, cognitive impairment, focal neurological deficits; “minor” were seizures, altered consciousness, psychiatric disorders. “Major” neuroradiological features were multiple parenchymal lesions, parenchymal/meningeal contrast enhancement, magnetic resonance angiography vessel abnormalities, vessel wall enhancement; “minor” were parenchymal/subarachnoid hemorrhage, single parenchymal lesion. The selected sets of criteria able to identify all PACNS patients were (1) one clinical (major/minor) + one major neuroradiological feature; and (2) Two clinical (≥ 1 major) + one minor neuroradiological feature. Conclusion Our review provides a detailed clinical/neuroradiological picture of PACNS. The proposed algorithm should be regarded as a preliminary screening tool to move the first steps towards PACNS diagnosis that needs validation.

show abstract

Section: Discussionmentioning

confidence: 99%

“When should primary angiitis of the central nervous system (PACNS) be suspected?”: literature review and proposal of a preliminary screening algorithm

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Others are conscious and describe the worst headache of their life, while others again report less severe and unspecific symptoms [ 3 ]. The wide spectrum of presentations makes SAH a challenging condition to recognize, especially among conscious patients with less severe symptoms which accounts for up to half of all SAH patients [ 4 , 5 ]. The uncharacteristic and diverse symptoms may result in initial under-triage and subsequent treatment delays even when patients are seen face-to-face by medical professionals in emergency departments [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Symptoms presented during emergency telephone calls for patients with spontaneous subarachnoid haemorrhage

Sonne

Egholm

Elgaard

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background A spontaneous subarachnoid haemorrhage (SAH) is one of the most critical neurological emergencies a dispatcher can face in an emergency telephone call. No study has yet investigated which symptoms are presented in emergency telephone calls for these patients. We aimed to identify symptoms indicative of SAH and to determine the sensitivity of these and their association (odds ratio, OR) with SAH. Methods This was a nested case–control study based on all telephone calls to the medical dispatch center of Copenhagen Emergency Medical Services in a 4-year time period. Patients with SAH were identified in the Danish National Patient Register; diagnoses were verified by medical record review and their emergency telephone call audio files were extracted. Audio files were replayed, and symptoms extracted in a standardized manner. Audio files of a control group were replayed and assessed as well. Results We included 224 SAH patients and 609 controls. Cardiac arrest and persisting unconsciousness were reported in 5.8% and 14.7% of SAH patients, respectively. The highest sensitivity was found for headache (58.9%), nausea/vomiting (46.9%) and neck pain (32.6%). Among conscious SAH patients these symptoms were found to have the strongest association with SAH (OR 27.0, 8.41 and 34.0, respectively). Inability to stand up, speech difficulty, or sweating were reported in 24.6%, 24.2%, and 22.8%. The most frequent combination of symptoms was headache and nausea/vomiting, which was reported in 41.6% of SAH patients. More than 90% of headaches were severe, but headache was not reported in 29.7% of conscious SAH patients. In these, syncope was described by 49.1% and nausea/vomiting by 37.7%. Conclusion Headache, nausea/vomiting, and neck pain had the highest sensitivity and strongest association with SAH in emergency telephone calls. Unspecific symptoms such as inability to stand up, speech difficulty or sweating were reported in 1 out of 5 calls. Interestingly, 1 in 3 conscious SAH patients did not report headache. Trial registration NCT03980613 (www.clinicaltrials.gov).

show abstract

“…При отсутствии травмы в анамнезе у данных пациентов часто выявляются признаки дисплазии соединительной ткани [21]. Присутствие синдрома Горнера, amaurosis fugax часто связано с диссекцией черепных артерий [22]. Кроме того, у женщин отмечается повышение риска тромбозов во время беременности и в послеродовом периоде, во время приема эстрогенсодержащих контрацептивов.…”

Section: особенности дифференциальной диагностики гбunclassified

Practical use of non-steroidal anti-inflammatory drugs in relieving recurrent headaches

Tabeeva¹,

Kiryanova²

2021

View full text Add to dashboard Cite

The main burden of headache in the world falls on primary cephalalgia (tension headache, migraine). However, there is often a need to rule out a secondary cause of the headache. This review presents the main options for the differential diagnosis of cephalgias, taking into account the patient’s age, headache characteristics, and anamnestic information. The role of non-steroidal anti-inflammatory drugs in headache treatment, the safety of its long-term use and prevention of medication overuse headache are discussed.

show abstract

Leading symptoms in cerebrovascular diseases: what about headache?

Cited by 23 publications

References 44 publications

“When should primary angiitis of the central nervous system (PACNS) be suspected?”: literature review and proposal of a preliminary screening algorithm

“When should primary angiitis of the central nervous system (PACNS) be suspected?”: literature review and proposal of a preliminary screening algorithm

Symptoms presented during emergency telephone calls for patients with spontaneous subarachnoid haemorrhage

Practical use of non-steroidal anti-inflammatory drugs in relieving recurrent headaches

Contact Info

Product

Resources

About