Value of CT angiography for the detection of intracranial vascular lesions in patients with acute severe headache

Eur Radiol. 2013 Jun;23(6):1443-9. doi: 10.1007/s00330-012-2751-4. Epub 2012 Dec 21.

Abstract

Objectives: To retrospectively investigate the prevalence and characteristics of intracranial vascular lesions in patients with acute severe headache with the use of CT angiography (CTA).

Methods: We systematically searched for neurologically intact patients with acute severe headache and normal unenhanced head CT. The study group consisted of 512 patients; 251 male; mean age 46.2 ± 12.4 years. All patients underwent CTA between 1 day and 2 months after the headache attack. CTA images were interpreted by two experienced neuroradiologists for the presence of vascular lesions.

Results: Thirty-four (6.6 %) of the 512 patients had intracranial vascular lesions on CTA, including 33 aneurysms (2 patients had 2 aneurysms each), 2 moyamoya disease and 1 arterial dissection. No gender- or age-related differences were found. Aneurysms arose most commonly on the internal carotid artery (n = 12), followed by the anterior communicating artery (n = 7), and the middle cerebral artery (n = 7). Maximal diameters ranged from 2.0 to 13.1 mm (mean, 3.9 ± 2.6 mm).

Conclusions: CTA is a feasible tool for diagnosing intracranial vascular lesions in patients with acute severe headache. The prevalence of vascular lesions in our series was 6.6 %, which is higher than that predicted in the general population.

Key points: • Unruptured cerebral aneurysms may be a cause of acute severe headache • CTA assesses intracranial vascular lesions in patients with acute severe headache • The prevalence of vascular lesions in our series of patients was 6.6 %

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Dissecting / diagnosis
  • Aneurysm, Dissecting / diagnostic imaging
  • Angiography, Digital Subtraction / methods
  • Carotid Artery, Internal / pathology
  • Cerebral Angiography / methods*
  • Female
  • Headache / diagnosis*
  • Headache / diagnostic imaging
  • Headache / etiology
  • Humans
  • Intracranial Aneurysm / diagnosis*
  • Intracranial Aneurysm / diagnostic imaging*
  • Male
  • Middle Aged
  • Middle Cerebral Artery / pathology
  • Moyamoya Disease / diagnosis
  • Moyamoya Disease / diagnostic imaging
  • Prevalence
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods*
  • Young Adult