动脉瘤性蛛网膜下腔出血后头痛病因学分析

Etiology of Headache after Aneurismal Subarachnoid Hemorrhage

目的分析动脉瘤性蛛网膜下腔出血(SAH)后头痛的病因。方法对107例发病后24h内CT诊断为SAH,并经全脑动脉造影(DSA)明确存在颅内动脉瘤的患者,分别在出血后1、2、3、5、7、10、14d行头痛数字评分(NRS),对中、重度头痛患者行头颅CT和经颅三维多普勒(TCD)检查,分析头痛发生原因,观察不同类型头痛的临床特点。结果86.9%(93/107)的动脉瘤性SAH患者病程中存在中、重度头痛,其中9.7%(9/93)源自动脉瘤再出血,其临床特点是突然出现剧烈头痛或原有头痛骤然加重,常伴有意识障碍或其他神经系统阳性体征;16.1%(15/93)的头痛患者CT显示继发性脑积水,且头痛多持续性加重,但有时可突然自行缓解;TCD检查显示12.9%(12/93)的头痛患者存在颅内血管痉挛,并可因病情持续加重出现局灶性神经功能缺损及意识障碍,61.3%(57/93)的患者无阳性发现,但临床表现类似。结论大多数动脉瘤性SAH患者存在中、重度头痛。

Objective To explore the etiology of headache after aneurismal subaraehnoid hemorrhage （SAH） and find clinical features of various kinds of headache. Methods All of the 107 patients with SAH and intraeranial aneurysm diagnosed upon CT scan and angiographie demonstration within 24 hours after onset were evaluated by numeric rating scales （NRS） 1,2,3,5,7,10 and 14 days after SAH. Patients suffered from moderate-severe headache were examined by cranial CT scan and transeranial Doppler （TCD） to find the reason, and their diversities were analyzed. Results 86. 9% （93/107） patients with SAH suffered from moderate-severe head- ache. 9.70//00 （9/93） of them were caused by rebleeding of untreated aneurysm and the pain always occurred abruptly, always followed by conscious disturbance/new neurological signs. CT scan found hydrocephalus in 16, 1M （15/93） patients with headache, they could aggravated with time but sometimes released spontaneously; TCD found intraeranial vasospasm in 12.9% （12/93） of patients, their clinical features were no more than other 61.3% （57/93） patients with negative results, but patienfs condition could ex- acerbate caused by later brain isehemia or even infarction. Conclusion Majority of SAH patients suffer from headache.