Jason William Romesburg DO, Presenter: Nothing to Disclose

Carol Geer MD, Abstract Co-Author: Nothing to Disclose

Christopher Thomas Whitlow MD, PhD, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to evaluate the clinical utility of head computed tomography angiography (CTA) in patients presenting with sudden onset headache (HA) concerning for possible aneurysmal subarachnoid hemorrhage (SAH). Our hypothesis was that CTA would not alter clinical management in most patients when non-contrast head CT and neurological exam were normal.

In this IRB approved HIPPA compliant case series, 1079 patients who received head CTA at Wake Forest University Baptist Medical Center between March 2007 and December 2011 were identified via retrospective chart review. Inclusion criteria included: chief complaint of abrupt onset HA and documentation of clinical concern for SAH/aneurysm as the indication for brain imaging. Primary exclusion criteria included: the presence of hemorrhage on non-contrast head CT and/or presentation with loss of consciousness, seizure, focal neurological symptoms, or history of recent trauma. Additional exclusion criteria included known history of cerebral aneurysm, intracranial neoplasm, vascular malformation, and family history of cerebral aneurysm. Results of non-contrast head CT, head CTA, and clinical evaluation data were examined.

355 patients met inclusion criteria. Of these, 5 (1.4%) intradural aneurysms (largest=3 mm) and 2 (0.6%) small extradural aneurysms were identified. None of the patients with aneurysms were admitted or underwent intervention. All aneurysms were thought to be incidental and unrelated to the patient’s headache by neurosurgery. There were 3 (0.8%) cases with vessel irregularity raising concern for reversible cerebral vasoconstrictive syndrome or vasculitis. Of these, only one patient was admitted, observed for 24 hours and discharged home on aspirin.

In our patient population, CTA changed clinical management in only 1 of 355 cases. Although a few small incidental aneurysms were identified with CTA, the number was not more than expected within the general population (1-2%). These findings suggest that CTA may be unnecessary in the evaluation of patients with sudden onset HA when non-contrast head CT and neurological examination are normal.

Head CTA may result in unnecessary cost and radiation exposure in the evaluation of patients with sudden onset headache when non-contrast head CT and neurological exam are normal.

Romesburg, J, Geer, C, Whitlow, C, Clinical Utility of CTA for Evaluating Etiology of Sudden Onset Headache.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043423.html