| Abstract | Cilj istraživanja: Cilj ove retrospektivne studije je analizirati obilježja i specifičnosti glavobolja koje odgovaraju kriterijima za glavobolju „poput udara groma” (engl. thunderclap headache, TCH), utvrditi njihovu etiologiju, različitosti i istražiti učestalost primarne TCH. Ispitanici i metode: U istraživanje je uključeno 84 bolesnika koji su u periodu od 1. siječnja 2021. do 31. prosinca 2023. godine došli u hitni prijem KBC Split zbog glavobolje koja odgovara kriterijima za TCH. Retrospektivno su prikupljeni anamnestički podatci i podatci o dijagnostičkoj obradi te statistički analizirani. Rezultati: Od 84 bolesnika 81 (96,43%) su prvi put doživjeli glavobolju „poput udara groma”. Hospitalizirano je 72 bolesnika (86,9%). Dijagnostička obrada započeta je nativnom CT‒om mozga, zatim se na temelju indikacija izvodila LP, CT ili MR angiografija, CT ili MR venografija i MR mozga. CT mozga izrađen je u 83 slučaja (98,81%). Kod 54 bolesnika (64,29%) pronađena je neurološka etiologija TCH, a 30 bolesnika (37,5%) dijagnosticirana je nespecifična glavobolja. Niti jednom bolesniku nije dijagnosticirana primarna TCH. Pronađena su 43 slučaja SAH‒a (51,19%) koji su dijagnosticirani na temelju nativnog CT‒a mozga (N = 38) ili analize CSF‒a nakon LP‒e (N = 7). CT ili MR angiografijom pronađeno je 29 bolesnika (67,44%) s aneurizmama, od njih troje (6,98%) je imalo multiple aneurizme. Raspon godina bolesnika sa SAH‒om bio je 30 do 82 godine s medijanom 54 godine. Nije pronađena statistički značajna razlika u incidenciji SAH‒a obzirom na dob. SAH se gotovo dva puta češće prezentirao u žena (67,44%) nego muškaraca (32,56%). Trećina bolesnika (34,88%) sa SAH‒om nije imala komorbiditete, a u bolesnika s komorbiditetima najčešći je bio arterijska hipertenzija (25,58%). Najčešći simptomi koji su pratili TCH u bolesnika sa SAH‒om bili su povraćanje (62,79%), mučnina (46,51%), poremećaj svijesti (30,23%), meningizam (27,91%) i fotofobija (16,28%). Preminulo je petero bolesnika (5,95%) ‒ jedan slučaj subduralnog krvarenja i četiri slučaja SAH‒a. Mortalitet SAH‒a bio je 9,3%. Zaključak: Većina bolesnika s TCH bila je hospitalizirana i detaljno obrađena do dobivanja konačne dijagnoze. Prva pretraga korištena za TCH je nativni CT mozga. Najčešći uzroci TCH su neurološke bolesti i stanja, poglavito SAH. Nije pronađen ni jedan slučaj primarne TCH. Izraz glavobolja „poput udara groma” (engl. thunderclap headache) trebao bi biti korišten kao klinički izraz za usmjeravanje dijagnostičke obrade, ne konačna dijagnoza. |
| Abstract (english) | Background: The aim of this retrospective study is to analyze the characteristics of thunderclap headaches (TCH) and determine their etiology, differences and investigate the frequency of primary TCH. Methods: The study included 84 patients who, in the period from January 1, 2021 to December 31, 2023, came to the emergency department of KBC Split due to a headache that meets the criteria for TCH. Retrospectively, anamnestic data and data on diagnostic processing were collected and statistically analyzed. Results: Out of 84 patients, 81 (96.43%) experienced TCH for the first time. 72 patients (86.9%) were hospitalized. Diagnostic workup began with non‒contrast brain CT, then, based on the indications, LP, CT or MR angiography, CT or MR venography and MR of the brain were performed. Brain CT was performed in 83 cases (98.81%). A neurological etiology of TCH was found in 54 patients (64.29%), and a non‒specific headache was diagnosed in 30 patients (37.5%). No patient was diagnosed with primary TCH. We found 43 cases of SAH (51.19%) that were diagnosed based on non‒contrast brain CT (N = 38) or CSF analysis after LP (N = 7). CT or MR angiography found 29 patients (67.44%) with aneurysms, three of them (6.98%) had multiple aneurysms. The age range of patients with SAH was 30 to 82 years with a median of 54 years. No statistically significant difference was found in the incidence of SAH with respect to age. SAH was obseved almost twice as often in women (67.44%) than in men (32.56%). A third of patients (34.88%) with SAH had no comorbidities, and in patients with comorbidities the most common was arterial hypertension (25.58%). The most common symptoms accompanying TCH in patients with SAH were vomiting (62.79%), nausea (46.51%), altered states of consciousness (30.23%), meningism (27.91%) and photophobia (16.28%). Five patients died (5.95%) ‒ one case of subdural hemorrhage and four cases of SAH. Mortality of SAH was 9.3%. Conclusion: Most patients with TCH were hospitalized and given an extensive workup until the final diagnosis was obtained. Diagnostic workup was initiated with non‒contrast brain CT. The most common causes of TCH are neurological diseases and conditions, especially SAH. Not a single case of primary TCH was found. The term "thunderclap headache" should be used as a clinical term to guide diagnostic workup, not a definitive diagnosis. |
