Headache as a first symptom of non-traumatic intracerebral hemorrhage

Abstract

Objective: Headache is a common symptom of cerebrovascular events, particularly of intracerebral hemorrhage (ICH), where it can occur at the onset or at some time in the course of the disease. The aim of this paper is to evaluate the important characteristics for the clinical course and outcome in a group of patients with headache at the onset of ICH. Patients and Methods: A prospective analysis of 144 patients with non-traumatic ICH, conservatively treated in a 2 1/4 year period at the Clinical Center of Serbia, Department of Emergency Neurology, Belgrade, was performed. The patients were divided in two groups based on the first symptoms of ICH. The first group consisted of patients in whom the ICH began with headache, nausea, and vomiting, while the second group included patients who had loss of consciousness, seizures, or focal neurological deficit. The groups were compared by age and gender, the existence of chronic hypertension, and the results of the first physical and neurological examination performed at admission. The results of these first examinations were scored by GCS and NESS. The location and size of the hematoma, the presence of edema, hydrocephalus, displacement of the medial brain structures, and intraventricular or subarachnoidal blood propagation was established by CT scan. The patients were followed for 30 days. Mortality and functional outcome of the surviving patients was then determined. These characteristics ware analyzed by Student-T and χ2 test. The significance was placed at p ≤ 0.05. Results: Of 144 patients with ICH, 43 (29.9 per- cent) had headache at the onset, 29 (20.1 percent) had loss of conscious- ness, 10 (6.9 percent) had epileptic seizures, and 62 (43.1 percent) had a focal neurological deficit. When clinical characteristics were compared, only the values of NESS were significantly lower in the headache group (13 ± 6.7), in comparison with the other patients (17 ± 6.4). When CT characteristics were compared, only the localization of the hematoma was significantly different Forty- seven percent of patients with lobar hematoma had headache, in comparison to 24 percent of the patients with basal-ganglion hematoma, in whom ICH more frequently began in another manner (76 percent). Conclusion: We conclude that almost one-third of patients with ICH have headache as a first symptom, which in some cases prolongs the time of recognition and appropriate treatment. The testing of clinical and CT characteristics showed that them are no features that differ in this group of patients in comparison with patients in whom ICH begins in another manner. A somewhat higher incidence of headache in the lobar hematoma group indicates arteriography is needed to fulfill the diagnosis. Although the patients with headache have a less dramatic onset of ICH than patients with loss of consciousness or hemiparesis, a similar mortality rate between these two groups of patients indicates that head- ache cannot be used as an element of prognosis in ICH.