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

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 %