Abstract
Objective
To find out predicting symptom(s) of non-traumatic subarachnoid haemorrhage in conscious patients without neurological deficit presenting with the primary complaint of severe headache.
Design
Case control study.
Setting
Regional public hospital, Hong Kong.
Subjects
Non-traumatic subarachnoid haemorrhage (ICD 9 coding 430) patients, who were conscious and with normal neurological examination, presenting to the accident and emergency department with severe headache between April 2005 to March 2007 were searched from the hospital database. The control group was recruited prospectively from the accident and emergency department during the period from November 2007 to April 2008.
Results
A total of 33 cases were compared to 57 controls to study on five selected symptoms and the likelihood to predict risk of subarachnoid haemorrhage. All five symptoms were significant by univariate analysis at significance level of 25%: nuchal pain (p<0.001), transient syncope (p=0.137), dizziness (p=0.026), vomiting (0=0.016) and presence of precipitating events (coitus, defecation or quarrel) (p=0.132). Only nuchal pain was statistically significant in the multivariate logistic regression analysis (OR=11.44; 95% CI=2.14 to 61.19) with age and gender controlled.
Conclusions
The presence of nuchal pain as a presenting symptom significantly increases the likelihood of non-traumatic subarachnoid haemorrhage by ten times among severe headache patients with normal neurological examination. Other symptoms like transient syncope, dizziness and vomiting are non-specific and do not predict a higher chance of occurrence of subarachnoid haemorrhage.