Neuroimaging evaluation in headache patients who have suffered a stroke or traumatic brain injury
DOI:
https://doi.org/10.48208/HeadacheMed.2022.4Keywords:
Stroke, Headache, Cerebral aneurysm, RMI, Computed tomography, EmergencyAbstract
In a medical emergency, the most urgent patients at significant risk of death are those with
a cerebrovascular accident and those with traumatic brain injury. Many are admitted with
diminished conscience status (coma) and focal neurological deficits. In the evaluation of
these patients, neuroimaging is indispensable in order to identify the type of lesion and
the location of the brain where it is located.
In the case of stroke, we can subdivide it into hemorrhagic and ischemic. Among hemorrhagic hemorrhages, we can mention (1) spontaneous intracerebral hematomas
and (2) hemorrhages due to rupture of an intracranial aneurysm, with subarachnoid
hemorrhage leading.
Patients with head trauma are critical; even those who arrive at the hospital alert and
oriented can decrease their level of consciousness in a few hours due to an intracranial
hematoma, edema, or cerebral contusion.
Thus, the availability of performing neuroimaging evaluations, using computed tomography and magnetic resonance imaging, or even digital angiography, is vital for continuous
supervision of this type of patient. The exams often require repetition several times due to
the rate of evolution of vascular lesions and after head trauma.
A warning sign in these types of patients is headache. In the intracranial aneurysmal rupture, we classically have the thunderclap headache, an explosive, sudden pain mentioned
as the worst pain the individual has suffered in his or her life. The pericranium and some
intracranial structures are sensitive to nociceptive stimuli, such as the dura mater, large
arteries, and venous sinuses. The brain is relatively insensitive to painful stimuli.
This narrative review aims to inform the importance of neuroimaging assessment of patients with stroke and traumatic brain injury in an emergency department. In conclusion,
a neuroimaging evaluation is paramount in addition to a neurological and physical
examination of the critically ill patient with cerebrovascular disease or who has suffered
a traumatic brain injury
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References
Gwarzo IH, Perez-Patron M, Xu X, Radcliff T
and Horney J. Traumatic Brain Injury Related
Hospitalizations: Factors Associated with In-hospital
Mortality among Elderly Patients Hospitalized with a
TBI. Brain Inj 2021;35(5):554-562 Doi:10.1080/0269 DOI: https://doi.org/10.1080/02699052.2021.1890822
2021.1890822
Ehelepola ND, Ranasinghe TI, Prashanthi B and
Bandara HM. An unusual presentation of a stroke in
a developing country: a case report. BMC Res Notes
;10(1):69 Doi:10.1186/s13104-017-2378-2 DOI: https://doi.org/10.1186/s13104-017-2378-2
Griesbach GS, Kreber LA, Harrington D and Ashley
MJ. Post-acute traumatic brain injury rehabilitation:
effects on outcome measures and life care costs. J
Neurotrauma 2015;32(10):704-711 Doi:10.1089/ DOI: https://doi.org/10.1089/neu.2014.3754
neu.2014.3754
Wiesmann M and Bruckmann H. [Diagnostic
imaging of acute head and brain injuries]. Radiologe
;38(8):645-658 Doi:10.1007/s001170050405 DOI: https://doi.org/10.1007/s001170050405
Brown AM, Twomey DM and Wong Shee A. Evaluating
mild traumatic brain injury management at a regional
emergency department. Inj Prev 2018;24(5):390-394 DOI: https://doi.org/10.1136/injuryprev-2018-042865
Doi:10.1136/injuryprev-2018-042865 DOI: https://doi.org/10.1136/injuryprev-2018-042865
Rizos T, Dorner N, Jenetzky E, Sykora M,
Mundiyanapurath S, Horstmann S, . . . Steiner
T. Spot signs in intracerebral hemorrhage: useful
for identifying patients at risk for hematoma
enlargement? Cerebrovasc Dis 2013;35(6):582-589 DOI: https://doi.org/10.1159/000348851
Doi:10.1159/000348851 DOI: https://doi.org/10.1159/000348851
Baye M, Hintze A, Gordon-Murer C, Mariscal T,
Belay GJ, Gebremariam AA and Hughes CML.
Stroke Characteristics and Outcomes of Adult Patients
in Northwest Ethiopia. Front Neurol 2020;11(428
Doi:10.3389/fneur.2020.00428 DOI: https://doi.org/10.3389/fneur.2020.00428
Xiao H, Yang Y, Xi JH and Chen ZQ. Structural
and functional connectivity in traumatic brain
injury. Neural Regen Res 2015;10(12):2062-2071 DOI: https://doi.org/10.4103/1673-5374.172333
Doi:10.4103/1673-5374.172328 DOI: https://doi.org/10.4103/1673-5374.172328
Silver AJ, Pederson ME, Jr., Ganti SR, Hilal SK and
Michelson WJ. CT of subarachnoid hemorrhage
due to ruptured aneurysm. AJNR Am J Neuroradiol
;2(1):13-22, https://www.ncbi.nlm.nih.gov/
pubmed/6784546
Zhang XH, Zhao XY, Liu LL, Wen L and Wang GX.
Identification of ruptured intracranial aneurysms
using the aneurysm-specific prediction score in
patients with multiple aneurysms with subarachnoid
hemorrhages- a Chinese population based external
validation study. BMC Neurol 2022;22(1):201
Doi:10.1186/s12883-022-02727-w DOI: https://doi.org/10.1186/s12883-022-02727-w
Goodfellow MJ, Medina JA, Proctor JL, Xu S, Gullapalli
RP, Rangghran P, . . . Fiskum G. Combined Traumatic
Brain Injury and Hemorrhagic Shock in Ferrets Leads to
Structural, Neurochemical, and Functional Impairments.
J Neurotrauma 2022;Doi:10.1089/neu.2022.0102 DOI: https://doi.org/10.1089/neu.2022.0102
Ahn SH, Savarraj JP, Pervez M, Jones W, Park J, Jeon
SB, . . . Choi HA. The Subarachnoid Hemorrhage
Early Brain Edema Score Predicts Delayed Cerebral
Ischemia and Clinical Outcomes. Neurosurgery
;83(1):137-145 Doi:10.1093/neuros/nyx364 DOI: https://doi.org/10.1093/neuros/nyx364
Quaid PT and Singman EL. Post-traumatic
headaches and vision: A review. NeuroRehabilitation
;50(3):297-308 Doi:10.3233/NRE-228013 DOI: https://doi.org/10.3233/NRE-228013
Russo A, D'Onofrio F, Conte F, Petretta V, Tedeschi G
and Tessitore A. Post-traumatic headaches: a clinical
overview. Neurol Sci 2014;35 Suppl 1(153-156 DOI: https://doi.org/10.1007/s10072-014-1758-9
Doi:10.1007/s10072-014-1758-9 DOI: https://doi.org/10.1007/s10072-014-1758-9
Tawk RG, Hasan TF, D'Souza CE, Peel JB
and Freeman WD. Diagnosis and Treatment
of Unruptured Intracranial Aneurysms and
Aneurysmal Subarachnoid Hemorrhage. Mayo
Clin Proc 2021;96(7):1970-2000 Doi:10.1016/j.mayocp.2021.01.005 DOI: https://doi.org/10.1016/j.mayocp.2021.01.005
Gilard V, Grangeon L, Guegan-Massardier E,
Sallansonnet-Froment M, Maltete D, Derrey S and
Proust F. Headache changes prior to aneurysmal
rupture: A symptom of unruptured aneurysm?
Neurochirurgie 2016;62(5):241-244 Doi:10.1016/j. DOI: https://doi.org/10.1016/j.neuchi.2016.03.004
neuchi.2016.03.004 DOI: https://doi.org/10.1088/1475-7516/2016/03/004
Parizel PM, Voormolen M, Van Goethem JW and
van den Hauwe L. Headache: when is neuroimaging
needed? JBR-BTR 2007;90(4):268-271, https://www.
ncbi.nlm.nih.gov/pubmed/17966243
Holle D and Obermann M. The role of neuroimaging
in the diagnosis of headache disorders.
Ther Adv Neurol Disord 2013;6(6):369-374 DOI: https://doi.org/10.1177/1756285613489765
Doi:10.1177/1756285613489765 DOI: https://doi.org/10.1177/1756285613489765
Parizel PM, Makkat S, Van Miert E, Van Goethem JW,
van den Hauwe L and De Schepper AM. Intracranial
hemorrhage: principles of CT and MRI interpretation.
Eur Radiol 2001;11(9):1770-1783 Doi:10.1007/ DOI: https://doi.org/10.1007/s003300000800
s003300000800
Ajiboye N, Chalouhi N, Starke RM, Zanaty M
and Bell R. Unruptured Cerebral Aneurysms:
Evaluation and Management. ScientificWorldJournal
;2015(954954 Doi:10.1155/2015/954954 DOI: https://doi.org/10.1155/2015/954954
Kwon OK. Headache and Aneurysm.Neuroimaging Clin N
Am 2019;29(2):255-260 Doi:10.1016/j.nic.2019.01.004 DOI: https://doi.org/10.1016/j.nic.2019.01.004
Zhang FL, Guo ZN, Liu Y, Luo Y and Yang Y.
Dissection extending from extra- to intracranial
arteries: A case report of progressive ischemic
stroke. Medicine (Baltimore) 2017;96(21):e6980 DOI: https://doi.org/10.1097/MD.0000000000006980
Doi:10.1097/MD.0000000000006980 DOI: https://doi.org/10.1097/MD.0000000000006980
Rodallec MH, Marteau V, Gerber S, Desmottes L and
Zins M. Craniocervical Arterial Dissection: Spectrum
of Imaging Findings and Differential Diagnosis.
RadioGraphics 2008;28(6):1711-1728 Doi:10.1148/ DOI: https://doi.org/10.1148/rg.286085512
rg.286085512
Schwartz NE, Vertinsky AT, Hirsch KG and
Albers GW. Clinical and radiographic natural
history of cervical artery dissections. J Stroke
Cerebrovasc Dis 2009;18(6):416-423 Doi:10.1016/j.
jstrokecerebrovasdis.2008.11.016 DOI: https://doi.org/10.1088/1126-6708/2008/11/016
Calabrese LH, Dodick DW, Schwedt TJ and
Singhal AB. Narrative Review: Reversible Cerebral
Vasoconstriction Syndromes. Annals of Internal
Medicine 2007;146(1):Doi:10.7326/0003-4819-146-
-200701020-00007
Valenca MM, Valenca LP, Bordini CA, da Silva
WF, Leite JP, Antunes-Rodrigues J and Speciali
JG. Cerebral vasospasm and headache during
sexual intercourse and masturbatory orgasms.
Headache 2004;44(3):244-248 Doi:10.1111/j.1526- DOI: https://doi.org/10.1111/j.1526-4610.2004.04054.x
2004.04054.x
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Copyright (c) 2022 Maria de Fátima Viana Vasco Aragão, Luziany Carvalho Araújo, Marcelo Moraes Valença
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