Headaches and Neuroimaging

Callaghan, Brian C.; Kerber, Kevin A.; Pace, Robert J.; Skolarus, Lesli E.; Burke, James F.

doi:10.1001/jamainternmed.2014.173

Cited by 70 publications

(21 citation statements)

References 5 publications

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“…This is likely due to the selection process and is consistent with the rate of use of MR imaging for neuroimaging in women in the literature. 15 Reassuringly, we found that the average angle for female controls was significantly lower than that of male controls, which would have only decreased the average control angle overall. We also excluded pediatric patients, who may experience changes in anatomy during development.…”

Section: Discussionmentioning

confidence: 66%

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

Wang

Pandey

Lee

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Classic findings of intracranial hypotension on MR imaging, such as brain stem slumping, can be variably present and, at times, subjective, potentially making the diagnosis difficult. We hypothesize that the angle between the cerebral peduncles correlates with the volume of interpeduncular cistern fluid and is decreased in cases of intracranial hypotension. We aimed to investigate its use as an objective assessment for intracranial hypotension. MATERIALS AND METHODS: Brain MRIs of 30 patients with intracranial hypotension and 30 age-matched controls were evaluated by 2 fellowship-trained neuroradiologists for classic findings of intracranial hypotension and the interpeduncular angle. Group analysis was performed with a Student t test, and receiver operating characteristic analysis was used to identify an ideal angle threshold to maximize sensitivity and specificity. Interobserver reliability was assessed for classic findings of intracranial hypotension using the Cohen value, and the interpeduncular angle, using the intraclass correlation. RESULTS: The interpeduncular angle had excellent interobserver reliability (intraclass correlation coefficient value ϭ 0.833) and was significantly lower in the intracranial hypotension group compared with the control group (25.3°versus 56.3°; P Ͻ .001). There was significant correlation between the interpeduncular angle and the presence of brain stem slumping (P Ͻ .001) and in cases with Ն3 classic features of intracranial hypotension (P ϭ .01). With a threshold of 40.5°, sensitivity and specificity were 80% and 96.7%, respectively. CONCLUSIONS: The interpeduncular angle is a sensitive and specific measure of intracranial hypotension and is a reliably reproducible parameter on routine clinical MR imaging.

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Section: Discussionmentioning

confidence: 66%

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

Wang

Pandey

Lee

et al. 2019

AJNR Am J Neuroradiol

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“…Silent brain infarcts are the most frequently identified incidental finding on brain scans. 3,89 With >1.5 million brain scans performed each year for headache alone in the United States, 181 many patients will have incidentally detected silent cerebrovascular disease. This unintended screening has potential benefit if it can be used to target health-promoting interventions to patients with silent cerebrovascular disease, but it also has potential risks if it leads to excessive testing or overtreatment, contributing to rising healthcare costs or even causing harm.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Smith¹,

Saposnik²,

Biessels³

et al. 2017

Stroke

318

297

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Abstract-Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians. (Stroke. 2017;48:e44-e71.

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“…The costs of neuroimaging for headache in the USA now total almost $1 billion per annum, much of which is unnecessary, in spite of guidelines to reduce unnecessary imaging. 29 This is simply not sustainable given the pressures to limit healthcare costs.…”

Section: Investigation Follows Clinical Assessment Not Beforementioning

confidence: 99%

Clinical neurology: why this still matters in the 21st century

Nicholl

Appleton

2014

Journal of Neurology, Neurosurgery & Psychiatry

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This review argues that even with the tremendous advances in diagnostic neuroimaging that the clinical skills involved in clinical neurology (ie, history, examination, localisation and differential diagnosis) remain key. Yet a number of recent audits suggest that large numbers of patients are failing to be assessed properly with a risk of patient harm, costly, unnecessary or inappropriate investigations, or delayed diagnosis. We review some of the reasons why patients are not being assessed properly neurologically, in part as many doctors have limited neurological exposure and are hence neurophobic. We propose that a solution to these issues centres around ensuring that a core set of basic neurological skills is taught at an undergraduate level, whereas higher level skills, such as the use of heuristics, are taught at postgraduate level.

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Headaches and Neuroimaging

Cited by 70 publications

References 5 publications

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Clinical neurology: why this still matters in the 21st century

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