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(Stroke. 2006;37:2733.)
© 2006 American Heart Association, Inc.

Original Contributions

Sentinel Headache and the Risk of Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Jürgen Beck, MD; Andreas Raabe, MD, PhD; Andrea Szelenyi, MD; Joachim Berkefeld, MD, PhD; Rüdiger Gerlach, MD, PhD; Matthias Setzer, MD Volker Seifert, MD, PhD

From the Department of Neurosurgery and the Institute of Neuroradiology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.

Correspondence to Jürgen Beck, MD, Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany. E-mail J.Beck{at}em.uni-frankfurt.de

Background and Purpose— The clinical significance of sentinel headaches in patients with subarachnoid hemorrhage (SAH) is still unknown. We investigated whether patients with a sentinel headache (SH) have a higher rate of rebleeding after SAH.

Methods— An SH was defined as a sudden, severe, unknown headache lasting >1 hour with or without accompanying symptoms, not leading to a diagnosis of SAH in the 4 weeks before the index SAH. Age, sex, smoking status, clinical grade, computed tomography (CT) findings, angiographic findings, placement of an external ventricular drain, and time to aneurysm obliteration were prospectively recorded. All rebleeding events were confirmed by CT. Outcome was assessed at 6 months according to the modified Rankin Scale.

Results— Of 237 consecutive patients with SAH, 41 (17.3%) had an SH. Rebleeding occurred in 23 (9.7%) of all patients. Patients with an SH had a 10-fold increased odds of rebleeding compared with patients without SH. Aneurysm size and the total number of aneurysms were also significantly associated with rebleeding. There were no differences in age, sex, smoking, CT or angiographic findings, external ventricular drain placement, or time to aneurysm obliteration between groups. Patients with rebeeding had a significantly worse outcome. Logistic regression revealed the presence of an SH as an independent risk factor for rebleeding.

Conclusions— In our study, patients with SAH who had an SH constituted a special group of patients with a 10-fold odds for early rebleeding. The presence of an SH may select candidates for ultraearly aneurysm obliteration or drug treatment.

Key Words: intracranial aneurysm • minor leak • rebleeding • sentinel headache • subarachnoid hemorrhage

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