Excluding subarachnoid haemorrhage within 24 hours: to LP or not to LP?

Chee, Carolyn; Roji, Akmal Mohamad; Lorde, Nathan; Divyateja, Hrushikesh; Dow, Graham; Shah, Jai; Chokkalingam, Kamal

doi:10.1080/02688697.2020.1781055

Cited by 3 publications

(6 citation statements)

References 29 publications

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“…However, if the new headache is associated with red flags, including a related activity or event (sexual activity, exertion, position), MRI of the head with and without intravenous contrast is usually appropriate (62). In a recent large cohort involving 999 patients with acute headache who presented to the emergency department, patients with time windows from ictus to brain CT of less than 24 hours had a sensitivity and specificity of 100% to exclude SAH (63).…”

Section: Diagnosismentioning

confidence: 99%

Update on primary headache associated with sexual activity and primary thunderclap headache

Lin

Chen

2023

Cephalalgia

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Background This narrative review aims to provide an update on primary headache associated with sexual activity and primary thunderclap headache. Methods We conducted a literature search on PubMed with the keywords “headache associated with sexual activity”, “sexual headache”, “orgasmic cephalalgia”, and “coital cephalalgia” in addition to “thunderclap headache” to assess the appropriateness of all published articles in this review. Results Primary headache associated with sexual activity is a “primary” headache precipitated by sexual activity, which occurs as sexual excitement increases (progressive at onset), or manifests as an abrupt and intense headache upon orgasm (thunderclap at onset) or combines these above two features. Primary headache associated with sexual activity is diagnosed after a thorough investigation, including appropriate neuroimaging studies, to exclude life-threatening secondary causes such as subarachnoid hemorrhage. According to the criteria of the third edition of the International Classification of Headache Disorders, primary thunderclap headache is also a diagnosis by exclusion. The pathophysiology of primary headache associated with sexual activity and primary thunderclap headache remains incompletely understood. Treatment may not be necessary for all patients since some patients with primary headache associated with sexual activity and primary thunderclap headache have a self-limiting course. Conclusion A comprehensive neuroimaging study is needed for distinguishing primary headache associated with sexual activity or primary thunderclap headache from secondary causes. Primary headache associated with sexual activity and primary thunderclap headache are self-limited diseases and the prognoses are good, but some patients with primary headache associated with sexual activity may have a prolonged course.

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Section: Diagnosismentioning

confidence: 99%

Update on primary headache associated with sexual activity and primary thunderclap headache

Lin

Chen

2023

Cephalalgia

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“…However, beyond 6 h, the sensitivity and specificity of brain CT decline significantly over time, down to 50% after one week, and to 30% after two weeks [15]. A study in 2020 involving 213 acute headache patients attempted to extend the time window to 24 h and reported a sensitivity and specificity both of 100% [16 ▪ ]. Further studies are needed to verify this finding.…”

Section: General Evaluationmentioning

confidence: 99%

Evaluating thunderclap headache

Chen

Fuh

2021

Current Opinion in Neurology

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Purpose of review Thunderclap headache (TCH) is an abrupt-onset of severe headache that needs to be thoroughly investigated because the most common secondary cause is subarachnoid hemorrhage (SAH). There has been no consensus guideline regarding the diagnostic workup. This review aims to provide an update on the evaluation of TCH. Recent findings The most important update in the 2019 American College of Emergency Physicians guideline for evaluation of acute headache in the emergency department is that negative noncontrast brain computed tomography (CT) findings within 6 h from ictus essentially excludes SAH. Additionally, the updated guideline recommends that after a negative brain CT, CT angiogram is a reasonable alternative to lumbar puncture if clinical suspicion of an intracranial source of SAH is high. An important update of reversible vasoconstriction syndrome (RCVS), the second most common etiology of TCH, is the RCVS2 score development based on clinical and radiological features, providing high specificity and sensitivity for distinguishing RCVS from other intracranial arteriopathies. Summary Although the evaluation of TCH is exhaustive, the potentially catastrophic consequence of a missed diagnosis of sentinel headache justifies the efforts. Awareness of the clinical features and application of diagnostic tools specific for different pathological conditions can facilitate the diagnostic workup.

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“…SAH has been reported in 1%-17% (average 7.5%) of patients presenting to emergency departments with acute headache [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Acute severe headache is usually not a symptom of a life‐threatening disorder, but may represent the first symptom of subarachnoid hemorrhage (SAH). SAH has been reported in 1%–17% (average 7.5%) of patients presenting to emergency departments with acute headache [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Most studies of acute headache including CT, LP and SAH are multicenter studies from referral hospitals with highly selected patient populations [ 2 , 6 , 8 , 9 , 10 , 16 , 17 , 18 , 19 , 20 ]. The prevalence of SAH in patients with acute headache in selected populations compared with more unselected populations from primary hospitals may differ.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic workup of acute headache and subarachnoid hemorrhage in a Norwegian population: An observational study

Aaseth,

Dhami,

Kravdal

et al. 2024

Euro J of Neurology

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BackgroundAcute headache may be the primary symptom of subarachnoid hemorrhage (SAH). Recent guidelines suggest that non‐contrast computed tomography (CT) is adequate to exclude aneurysmal SAH if performed within 6 h after symptom onset. However, most studies of acute headache including CT, lumbar puncture and SAH are multicenter studies from referral hospitals with highly selected patient populations. The main purpose of this study was to describe the diagnostic properties of head CT and cerebrospinal fluid (CSF) spectrophotometry for detecting SAH in an unselected primary hospital population with acute headache.MethodsA retrospective cross‐sectional study conducted at a large primary hospital serving roughly 10% of the Norwegian population. Diagnostic workup from consecutive patients evaluated for acute headache in 2009–2020 were collected. All CSF‐spectrophotometry reports were standardized and the same CT scanner was used during the study.ResultsA total of 3227 patients were included. Median age was 45 years and 63% were women. In total, 170 (5.3% of all acute headache patients) had SAH. Of 3071 CT‐negative patients, 2852 (93%) underwent lumbar puncture. Of the CSF reports, 2796 (98%) were negative for xanthochromia. Overall, the rate for detection of aneurysmal SAH by positive xanthochromia was 9 in 2852 cases (3‰). The miss rate for the detection of an aneurysmal SAH with a CT scan within 6 h was 0 and within 12 h 1 in 2852 cases (0.3‰).ConclusionIn acute headache, a CT scan taken within 6 h is practically 100% sensitive for detecting any SAH.

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Excluding subarachnoid haemorrhage within 24 hours: to LP or not to LP?

Cited by 3 publications

References 29 publications

Update on primary headache associated with sexual activity and primary thunderclap headache

Update on primary headache associated with sexual activity and primary thunderclap headache

Evaluating thunderclap headache

Diagnostic workup of acute headache and subarachnoid hemorrhage in a Norwegian population: An observational study

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