背景:心脏损害在急性脑损伤患者中很常见;然而,对心脏引起的神经症状知之甚少。在头痛的国际分类中,第三版(ICHD-III),心源性头痛被归类为由稳态受损引起的头痛。
方法:本报告介绍了4例急性心肌梗死(AMI)患者,他们的头痛符合ICHD-III诊断标准。还介绍了使用系统评估和荟萃分析指南的首选报告项目对心脏性头痛的系统评估。
结果:案例1:一名有经皮冠状动脉介入治疗(PCI)病史的69岁男性突然出现严重的枕骨疼痛,恶心,冷汗。冠状动脉造影(CAG)显示右冠状动脉(RCA)闭塞。案例2:一名66岁的妇女抱怨骑自行车时枕骨和胸部不适增加。CAG显示左前降支狭窄99%。案例3:一名54岁男子出现昏厥,冷汗,吃完午饭后的枕骨。CAG检测到RCA的闭塞。案例4:一名72岁的男子因突然出现剧烈的头痛和恶心而休克。启动血管加压药并进行紧急CAG,检测到三血管疾病。在所有四个中,心电图(ECG)显示ST段抬高或压低,超声心动图显示左心室壁运动异常。所有患者均接受PCI,成功进行冠状动脉再灌注后头痛消退。回顾性分析59例心源性头痛患者的临床资料,包括这里报道的四个人。虽然心源性头痛的典型表现是劳累时偏头痛样疼痛,它可能会出现雷击头痛,而没有触发或胸部症状,模仿蛛网膜下腔出血。心电图可能并不总是显示异常。成功的冠状动脉再灌注后头痛缓解。
结论:由AMI引起的心脏性头痛可出现或不出现胸部不适,甚至模拟与SAH相关的经典雷击性头痛。应将其视为神经系统紧急情况,并立即治疗。
BACKGROUND: Cardiac damage is common in patients with acute brain injury; however, little is known regarding cardiac-induced neurological symptoms. In the International Classification of Headache, Third Edition (ICHD-III), cardiac cephalalgia is classified as a headache caused by impaired homeostasis.
METHODS: This report presents four patients with acute myocardial infarction (AMI) who presented with headache that fulfilled the ICHD-III diagnostic criteria for cardiac cephalalgia. A systematic review of cardiac cephalalgia using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines is also presented.
RESULTS: Case 1: A 69-year-old man with a history of percutaneous coronary intervention (PCI) developed sudden severe occipital pain, nausea, and cold sweating. Coronary angiography (CAG) revealed occlusion of the right coronary artery (RCA). Case 2: A 66-year-old woman complained of increasing occipitalgia and chest discomfort while riding a bicycle. CAG demonstrated 99% stenosis of the left anterior descending artery. Case 3: A 54-year-old man presented with faintness, cold sweating, and occipitalgia after eating lunch. CAG detected occlusion of the RCA. Case 4: A 72-year-old man went into shock after complaining of a sudden severe headache and nausea. Vasopressors were initiated and emergency CAG was performed, which detected three-vessel disease. In all four, electrocardiography (ECG) showed ST segment elevation or depression and echocardiography revealed a left ventricular wall motion abnormality. All patients underwent PCI, which resulted in headache resolution after successful coronary reperfusion. A total of 59 cases of cardiac cephalalgia were reviewed, including the four reported here. Although the typical manifestation of cardiac cephalalgia is migraine-like pain on exertion, it may present with thunderclap headache without a trigger or chest symptoms, mimicking subarachnoid hemorrhage. ECG may not always show an abnormality. Headaches resolve after successful coronary reperfusion.
CONCLUSIONS: Cardiac cephalalgia resulting from AMI can present with or without chest discomfort and even mimic the classic thunderclap headache associated with SAH. It should be recognized as a neurological emergency and treated without delay.