NEURO Value of CT angiography for the detection of intracranial vascular lesions in patients with acute severe headache Ari Han & Dae Young Yoon & Eun Soo Kim & Heung Cheol Kim & Byung-Moon Cho & Jong Young Lee Received: 22 September 2012 / Revised: 16 November 2012 / Accepted: 21 November 2012 / Published online: 21 December 2012 # European Society of Radiology 2012 Abstract Objectives To retrospectively investigate the prevalence and characteristics of intracranial vascular lesions in patients with acute severe headache with the use of CT angiography (CTA). Methods We systematically searched for neurologically in- tact patients with acute severe headache and normal unen- hanced head CT. The study group consisted of 512 patients; 251 male; mean age 46.2±12.4 years. All patients under- went CTA between 1 day and 2 months after the headache attack. CTA images were interpreted by two experienced neuroradiologists for the presence of vascular lesions. Results Thirty-four (6.6 %) of the 512 patients had intracra- nial vascular lesions on CTA, including 33 aneurysms (2 patients had 2 aneurysms each), 2 moyamoya disease and 1 arterial dissection. No gender- or age-related differences were found. Aneurysms arose most commonly on the internal carotid artery (n 0 12), followed by the anterior communicating artery (n 0 7), and the middle cerebral artery (n 0 7). Maximal diameters ranged from 2.0 to 13.1 mm (mean, 3.9±2.6 mm). Conclusions CTA is a feasible tool for diagnosing intracra- nial vascular lesions in patients with acute severe headache. The prevalence of vascular lesions in our series was 6.6 %, which is higher than that predicted in the general population. Key Points • Unruptured cerebral aneurysms may be a cause of acute severe headache • CTA assesses intracranial vascular lesions in patients with acute severe headache • The prevalence of vascular lesions in our series of patients was 6.6 % Keywords Intracranial aneurysm . CT angiography . Headache . Screening . Prevalence Introduction Acute severe headache is a common presenting complaint for 1–2 % of patients who attend the emergency department [1]. Most have primary headache disorders (such as mi- graine and tension-type headache) associated with benign clinical course; however, a subgroup of 1–4 % of these patients has a potentially life-threatening subarachnoid haemorrhage (SAH) [1–3]. Cerebral aneurysm without SAH has also been postulated as a cause of acute severe headache. It has been reported that 15–37 % of patients with documented SAH have experi- enced an attack of acute severe headache before the index episode of bleeding [4–7]. Although digital subtraction angiography (DSA) has been the “gold standard” diagnostic test in this clinical A. Han : D. Y. Yoon(*) Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong Kangdong-Gu, Seoul 134-701, Korea e-mail: evee0914@chol.net E. S. Kim Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyongchon-dong, Dongan-Gu, Anyang, Gyeonggi-do 431-070, Korea H. C. Kim Department of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 153 kyo-dong, Chuncheon, Kangwon-do 200-060, Korea B.-M. Cho : J. Y. Lee Department of Neurosurgery, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong Kangdong-Gu, Seoul 134-701, Korea Eur Radiol (2013) 23:1443–1449 DOI 10.1007/s00330-012-2751-4