ORIGINAL ARTICLEThunderclap Headache and Normal Computed Tomographic Results: Value of Cerebrospinal Fluid Analysis
Section snippets
PATIENTS AND METHODS
A retrospective study of alert, neurologically intact, nontraumatic patients with TCH presenting to the ED of Saint Marys Hospital (Rochester, MN) between January 1, 1998, and January 1, 2008, was conducted. Alert was defined as a Glasgow Coma Scale score of 15. Nontraumatic was defined as the absence of falls or direct trauma to the head in the previous 14 days. Thunderclap headache was defined as a sudden and severe headache with maximum intensity at onset. All patients presented less than 2
RESULTS
Of the 4662 patients who presented with headache, 642 patients (14%) characterized their headache as “the worst of their life.” Only 152 patients (3%) described a sudden, severe headache, maximal at onset, despite a normal head CT result. Data analysis is limited to these 152 patients. A study flowchart is illustrated in Figure 1. The mean ± SD age of the patients was 44.7±15.8 years. The female-male ratio was 1.9:1. The mean elapsed time between the onset of headache and the CT study was 29.5
DISCUSSION
To our knowledge, our study of consecutive patients who presented to the ED with TCH and normal CT results shows for the first time that visual detection of CSF xanthochromia has a high PPV (72% in our population) for the presence of aneurysm on cerebral angiography. We also found that the red blood cell and total nucleated cell counts in the CSF were significantly higher in patients with angiographically documented aneurysms. Thus, these CSF parameters may be useful when trying to exclude the
CONCLUSION
Evidence of CSF xanthochromia on visual inspection in patients with TCH and negative CT results is associated with a high likelihood of finding an aneurysm on conventional angiography. Visual inspection and spectrophotometry for the evaluation of xanthochromia may provide complementary information to the ED physician triaging these patients. Physicians should be aware of each test's characteristics to ensure its proper use in the decision-making process. Elevated cell counts in the CSF may also
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