The utility of neuroimaging in the evaluation of headache in patients with normal neurologic examinations

Frishberg, Benjamin

doi:10.1212/wnl.44.7.1191

Cited by 134 publications

(85 citation statements)

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“…Only 0.4% of a total of 897 migraineurs harbored an intracranial lesion disclosed by either CT or MRI (3 tumors and 1 MAV) 6 . As a result of such very low prevalence of serious intracranial lesions, the Quality Standards Subcommittee stated that "in adult patients with recurrent headaches that have been defined as migraine -including those with visual aura -with no recent change in pattern, no history of seizures, and no other focal neurologic signs or symptoms, the routine use of neuroimaging is not warranted."…”

Section: Discussionmentioning

confidence: 99%

Computed tomography scan of the head in patients with migraine or tension-type headache

Valênça

Valença

Menezes³

2002

Arq. Neuro-Psiquiatr.

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-A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT) scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%), cysticercosis (3.9%), unruptuted cerebral aneurysm (2.6%), basilar impression (2.6%), intracranial lipoma (2.6%), arachnoid cyst (2.6%), empty sella (2.6%), intracranial neoplasm (2.6%), and others (2.6%). None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.KEY WORDS: headache, migraine, tension-type, CT scan, basilar impression, cysticercosis. T T T T Tomografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional RESUMO -Um estudo retrospectivo foi realizado visando avaliar a frequência de anormalidades encontradas durante a realização de estudo por tomografia computadorizada (TC) em 78 pacientes com migrânea ou cefaléia do tipo tensional. A TC foi normal em 61,5% dos pacientes examinados. Em um terço dos pacientes estudados foram detectadas anormalidades, como doença inflamatória dos seios paranasais (19,2%), cisticercose (3,9%), aneurisma cerebral não-roto (2,6%), impressão basilar (2,6%), lipoma intracraniano (2,6%), cisto aracnoideo (2,6%), sela vazia (2,6%), neoplasia intracraniana (2,6%) e outras afecções (2,6%). Nenhuma destas lesões era sintomática (achado incidental). Concluindo, o encontro fortuito de algumas anormalidades na TC é frequentemente mais elevado do que se prediz em pacientes com cefaléia primária. Nós discutimos brevemente alguns aspectos clínicos, epidemiológicos e da conduta terapêutica-cirúrgica sobre algumas das anomalias diagnosticadas pela TC. Também levantamos, ou questionamos, aspectos éticos que determinam o limite entre o direito do paciente e o direito do médico em afirmar que um indivíduo com dor de cabeça não é portador de lesão intracraniana, baseado na história clínica e no exame físico do paciente.

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Section: Discussionmentioning

confidence: 99%

Computed tomography scan of the head in patients with migraine or tension-type headache

Valênça

Valença

Menezes³

2002

Arq. Neuro-Psiquiatr.

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“…16,17 The yield from neuroimaging, though low, is not zero. 18,19 The dilemma is that many headache patients, even in the United Kingdom, which operates a family physician system, remain unassured after neurological consultation, and some may request further investigations. 20 In a health care system equipped to provide superior follow-up care, patients might accept reassurance reluctantly while neuroimaging is deferred until a change in their clinical condition warrants it.…”

Section: Discussionmentioning

confidence: 99%

“…20 In a health care system equipped to provide superior follow-up care, patients might accept reassurance reluctantly while neuroimaging is deferred until a change in their clinical condition warrants it. 15,19 Chronic headache which has not changed in character may, however, be associated with brain tumor. 21,22 Where neurological expertise is in short supply and follow-up is uncertain, the cost and inconvenience of repeated visits to clinics far removed from patients in the hope of a "cure" for chronic isolated headache, the economic cost of lost time and reduced effectiveness of performance at work, 23 and the anxiety engendered by a perceived potentially lifethreatening ailment, may influence the need for earlier neuroimaging in the investigation of the headache patient.…”

Section: Discussionmentioning

confidence: 99%

Profile of Chronic Headache Patients in the Asir Region: A Three-Year Study in Asir Central Hospital, Abha

Longe

1998

Ann Saudi Med

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“…En yaygõn görüleni bizim olgumuzda da görülen ve tanõyõ şiddetle destekleyen pakimeningeal kalõnlaşma ve yoğun kontrast tutulumudur. 4,5,10 Spinal, özellikle de servikal bölge MRG'sinde sõk olarak anterior internal vertebral pleksusta önemli dilatasyon ve de higromalar görülebileceği bildirilmiştir. 4 Bizim olgumuzun spinal MRG'leri normal bulunmuştur.…”

Section: 4912unclassified

“…Kraniyal MRG'de tipik sayõla-bilecek, diffüz pakimeningeal kalõnlaşma ve gadolinum tutulumu görülür. 10,11 Daha nadir olarak subdural koleksiyon, serebral venöz sinüslerde tõkanma, pitüiter glandda genişleme veya ventriküllerde küçülme görülebilir. http://www.ctf.istanbul.edu.tr/dergi/online/2002v33/s3/023o2.pdf U Klinikten sorumlu olan genellikle spontan olarak ortaya çõkmõş dural bir yõrtõk ve oradan BOS sõzmasõna bağlõ olarak BOS volüm ve basõncõnõn azalmasõdõr.…”

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Spontan intrakranyal hipotansiyon: Olgu sunumu

Al¹

2009

jaem

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The utility of neuroimaging in the evaluation of headache in patients with normal neurologic examinations

Cited by 134 publications

References 0 publications

Computed tomography scan of the head in patients with migraine or tension-type headache

Computed tomography scan of the head in patients with migraine or tension-type headache

Profile of Chronic Headache Patients in the Asir Region: A Three-Year Study in Asir Central Hospital, Abha

Spontan intrakranyal hipotansiyon: Olgu sunumu

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