The Study Of Clinical Characteristics Associated With Sentinel Headache In Patients With Unruptured Intracranial Aneurysm

Background:Patients with unruptured intracranial aneurysms may develop a sentinel headache before the rupture of aneurysm which could lead to subarachnoid hemorrhage.Therefore,sentinel headache can be viewed as a signal to identify the impending rupture of aneurysm.Many retrospective studies have shown that 15%-60% of patients with aneurysmal subarachnoid hemorrhage have sentinel headaches.However,most of the studies confirmed the existence of sentinel headaches through a review of history after onset of hemorrhage.There are few studies on the headache before the rupture of intracranial aneurysms.Thus,it is hard to distinguish whether the headaches of patients with intracranial aneurysms are associated with aneurysms.And some researchers questioned the existence of sentinel headache and attributed its high incidence to retrospective bias.This study collects cases of unruptured intracranial aneurysms diagnosed in our center and divided them into groups with or without headaches to investigate the existence and clinical characteristics of sentinel headache associated with aneurysms.Objectives:To investigate the existence of sentinel headache and its associated clinical characteristics in patients with unruptured aneurysms.To better identify the sentinel headache which is caused by aneurysm.Thus,a reference for the further treatment of patients with unruptured aneurysms can be provided.Methods:We collected 36 cases of single unruptured intracranial aneurysm diagnosed by digital subtraction angiography(DSA)and examined by susceptibility weighted imaging(SWI)in the department of vascular neurosurgery of the first hospital of Jilin University from November 2018 to November 2019.By means of retrospective analysis and dividing patients according to the presence or absence of specific headache symptoms,we collected the basic data of patients,SWI results,aneurysm location,size,morphological parameters and PHASES Score for statistical analysis to explore the relevant clinical characteristics of sentinel headache in patients with intracranial aneurysms.Results:There were 15 patients with sentinel headache.The average age(± SD)was 58.07±8.23 and 9 patients were female(60%).There were 21 patients without sentinel headache.The average age(± SD)was 58.57±8.09 and 15 patients were female(71.43%).The average PHASES Score(± SD)of patients with sentinel headache was 7.47±2.97 and the average PHASES Score(± SD)of patients without sentinel headache was 5.52±3.79.Statistically significant difference exists between two groups(p=0.044).In univariate analysis,there were no statistically significant difference in age,gender,aneurysm size,aneurysm irregularity,Size Ratio,Aspect Ratio,hypertension,and diabetes in the two groups.There were 10 patients(80.33%)in the sentinel headache group who had aberrant signals in SWI and 3 patients(21.43%)in the non-sentinel headache group.Statistically significant difference exists between two groups(p=0.005).The average Inflow Angle(± SD)in the sentinel headache group and non-sentinel headache group were 129.72±26.23° and 108.03±32.71° respectively.Statistically significant difference exists between two groups(p=0.022).In multivariate analysis,aberrant signal in SWI was independent relevant factor(p=0.001).For the 9 patients with sentinel headache and who had aberrant signals in SWI in the meanwhile,Statistically significant differences exist in aneurysm size,Size Ratio,Aspect Ratio and Inflow Angle compared with patients without sentinel headache in univariate analysis(p=0.048,p=0.037,p=0.046,p=0.046).In multivariate analysis,Aspect Ratio was the independent relevant factor(p=0.047).Conclusions: 1.Sentinel headache is virtually present in patients with unruptured intracranialaneurysms and is related to the risk of aneurysm rupture.Further intervention treatment can be considered for patients with sentinel headache to avoid aneurysm rupture.2.Aberrant signals in susceptibility weighted imaging are associated with sentinel headache in patients with unruptured intracranial aneurysms,which can be viewed as a clinical feature to identify aneurysm-related sentinel headache.3.Sentinel headache may also be related to the morphological parameters of the aneurysm.More studies are warranted for their relation.