2014 年 42 巻 2 号 p. 122-126
To prevent rebleeding of a subarachnoid hemorrhage (SAH) due to intracranial artery aneurysms, early treatment is indispensable. We investigated such cases at the time of initial diagnosis of walk-in patients in hospitals. The study covered 293 patients with SAH caused by ruptured intracranial artery aneurysms who were hospitalized in our department between 1996 and 2005. The individuals were treated at the Yamagata University between 1996 and 2005. All 293 cases had a sudden onset. In 89 cases (30.3%), the individuals consulted physicians at various medical facilities without the use of ambulances.
In 129 of these cases (44%), the individuals presented with headache only, including Hunt & Kosnik (H&K) Grade I: 27 (9.2%) and Grade II: 102 (34.8%). These findings revealed that headache is common in such cases. Moreover, 24 of the 27 (88.9%) cases of H&K Grade I and 65 of 102 (63.7%) cases of Grade II were walk-in patients, and the consultation rate of walk-in patients presenting only a headache was very high. The average number of days that individuals waited before consulting a physician was 2.2 (0–35 days). Of the 89 cases of walk-in patients, 24 were very difficult to diagnose (26.9%). Two cases (both H&K I) were difficult to diagnose even under CT examination, and 22 cases (H&K I: 8, II: 14) were not suspected to be SAH cases, and their CT were not examined. These difficult cases were first diagnosed as follows: common cold, 4; high blood pressure, 2; facial palsy for oculomotor nerve paralysis, 1; and ordinary headache, 17. Of these 24 cases for which a confirmed diagnosis was difficult, upon subsequent visits, 18 were diagnosed as having persistent headache; 5, rerupture of SAH (admitted by ambulance); and 1, symptomatic spasm (admitted by ambulance). The location of aneurysms of the walk-in 89 patients were ICA: 21, MCA: 22, ACA: 34, VBA: 3, and other: 9. The overall results of the walk-in 89 patients were GR: 73 (82%), MD: 9 (10%), SD: 1 (1%), D: 6 (7%).
Our investigation indicated that difficulty in making a confirmed diagnosis is not rare when only the symptoms are considered.