Clinical Predictors of Abnormalities in Headache Patients as Confirmed by Three-Dimensional Computed Tomographic Angiography

ABSTRACT

PURPOSE: Headache patients with an alert mental state and normal neurologic examination findings who visit the emergency department (ED) should be differentially diagnosed for the presence of cerebral vessel disease. Hence, the purpose of this study was to analyze the abnormal three-dimensional cerebral computed tomographic angiography (3D-CTA) findings of mentally alert patients presenting headache, and investigate the clinical factors predictive of an intracranial abnormality. METHODS: A total of 227 patients visiting the ED presenting headache and possessing an alert mental status were enrolled in this study and examined by 3D-CTA from January 2008 to December 2008. We compared the results of the 3D-CTA and the final clinical diagnosis for each patient. The patient participants were divided into two groups an abnormal group, as confirmed by 3D-CTA, and a non-abnormal group. We compared the vital signs, past hypertension history, clinical manifestations, and the clinical factors predictive of abnormality between the two groups. RESULTS: Of the total patients, 44 were identified with abnormal findings by non-enhanced CT, and 61 patients were identified with abnormal findings by 3D-CTA. SAH was found in 29 patients and unruptured aneurysm was discovered in 17 patients using 3D-CTA. The time interval between onset of headache to arrival at the ED was shorter in the SAH group (p=0.012), and sudden bursting headache was observed in 22 subarachnoid hemorrhage (SAH) patients (p<0.001). Statistically significant differences were observed between the two groups for symptoms of nausea, vomiting, neck stiffness and seizure. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables that affected the abnormal 3D-CTA group. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables for the abnormal 3D-CTA group. CONCLUSION: Sudden bursting headache, neck stiffness, vomiting, and advanced age were independent predictable variables observed in the abnormal 3D-CTA group.