Neuroimaging in the Evaluation of Patients with Non-Acute Headache

Áp, Sempere; Porta‐Etessam, Jesús; Medrano, V; García‐Morales, Irene; Concepción, Luis; Ramos, Ana; Florencio, Ignacio; Bermejo, F; Botella, Cristina

doi:10.1111/j.1468-2982.2004.00798.x

Cited by 113 publications

(85 citation statements)

References 24 publications

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“…37 The risk in migraine was 0.4% and in tension-type headache 0.8%. Previous secondary care studies of consecutive non-acute isolated headache quoted abnormalities for migraine as 0-3.1% and unspecified headache 0-6.7%.…”

Section: Box 1 Three Levels Of Risk Of Brain Tumour and Suggested Mamentioning

confidence: 99%

Imaging patients with suspected brain tumour: guidance for primary care

Kernick

Ahmed²,

Bahra

et al. 2008

Br J Gen Pract

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The number of referrals by primary care practitioners to secondary care neurology services, particularly for headache, may be difficult to justify. Access to imaging by primary care practitioners could avoid referral without compromising patient outcomes, but the decision to refer is based on a number of complex factors. Due to the paucity of rigorous evidence in this area, available data are combined with expert opinion to offer support for GPs. The study suggests management for three levels of risk of tumour: red flags >1%; orange flags 0.1-1%; and yellow flags <0.1% but above the background population rate of 0.01%. Clinical presentations are stratified into these three groups. Important secondary causes of headache where imaging is normal should not be overlooked, and normal investigation does not eliminate the need for follow-up or appropriate management of headache.

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Section: Box 1 Three Levels Of Risk Of Brain Tumour and Suggested Mamentioning

confidence: 99%

Imaging patients with suspected brain tumour: guidance for primary care

Kernick

Ahmed²,

Bahra

et al. 2008

Br J Gen Pract

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“…The yield of significant pathological findings in this study was 1.4%, and this is consistent with findings in other populations of patients with chronic headache. 6,12,23 Results of the questionnaire sent to GPs who had used the service show that it may have prevented a neurology referral in 88% of cases. As the CT scan was said to have caused a referral in 5% of cases, one could assume that the predicted reduction in clinic referrals would be 83%.…”

Section: Summary Of Main Findingsmentioning

confidence: 99%

“…8 The role of imaging in this situation has been extensively reviewed, and guidance has been published for risk which stratifies patients according to presentation. 9,10 Although pathology may be excluded by neuroimaging, the diagnostic yield is low, 9,11,12 and the duration of reassurance for patients is short. 13 Moreoever, there is a risk of finding coincidental abnormalities that may generate more anxiety.…”

Section: Introductionmentioning

confidence: 99%

Primary care access to computed tomography for chronic headache

Thomas¹,

Cook²,

Main³

et al. 2010

Br J Gen Pract

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The diagnostic yield of neuroimaging in chronic headache is low, but can reduce the use of health services. AimTo determine whether primary care access to brain computed tomography (CT) referral for chronic headache reduces referral to secondary care. Design of studyProspective observational analysis of GP referrals to an open access CT brain scanning service. SettingPrimary care, and outpatient radiology and neurology departments. MethodGPs in Tayside and North East Fife, Scotland were given access to brain CT for patients with chronic headache. All referrals were analysed prospectively over 1 year, and questionnaires were sent to referrers to establish whether imaging had resulted in or stopped a referral to secondary care. The Tayside outpatient clinic database identified scanned patients referred to the neurology clinic for headache from the start of the study period to at least 1 year after their scan. ResultsThere were 232 referrals (55.1/100 000/year, 95% confidence interval = 50.4 to 59.9) from GPs in 59 (82%) of 72 primary care practices. CT was performed on 215 patients. Significant abnormalities were noted in 3 (1.4%) patients; there were 22 (10.2%) nonsignificant findings, and 190 (88.4%) normal scans. Questionnaires of the referring GPs reported that 167 (88%) scans stopped a referral to secondary care. GPs referred 30 (14%) scanned patients to a neurologist because of headache. It is estimated that imaging reduced referrals to secondary care by 86% in the follow-up period. ConclusionAn open access brain CT service for patients with chronic headache was used by most GP practices in Tayside, and reduced the number of referrals to secondary care.

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“…This is also a noninvasive investigation (12). It may also be used in antenatal judgment of hydrocephalus.…”

Section: Magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

Pediatric Endoscopic Third Ventriculostomy: A Narrative Review of Current Indications, Techniques and Complications

Haddadi¹

2016

J Pediatr Rev

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Hydrocephalus is a disorder in which excess cerebrospinal fluid (CSF) collects in the brain. Possible managements for hydrocephalus contain CSF deviation through ventriculoperitoneal shunt assignment and endoscopic third ventriculostomy. An endoscopic third ventriculostomy has been in trend for the past two decades, as a tool in the field of the neurosurgery, for the management of hydrocephalus. Its utility has been confirmed consistently in congenital and acquired aqueductal stenosis, although the outcomes in communicating hydrocephalus and hydrocephalus secondary to other etiologies have not been impressive. It is a relatively harmless technique with the appropriate selection of patients with a low rate of enduring morbidity. Further studies in child should focus on the predictive factors that are specific to the older population. A combination of clinical, radiological, and intraoperative findings may be necessary to plan a clinical prediction rule suitable to this group of patients. The purpose of this review is to describe the current indications, management outcomes, techniques and complications of this method.

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Neuroimaging in the Evaluation of Patients with Non-Acute Headache

Cited by 113 publications

References 24 publications

Imaging patients with suspected brain tumour: guidance for primary care

Imaging patients with suspected brain tumour: guidance for primary care

Primary care access to computed tomography for chronic headache

Pediatric Endoscopic Third Ventriculostomy: A Narrative Review of Current Indications, Techniques and Complications

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