Repeat CT or MRI in Posttraumatic Headache

Repeat CT or MRI of the brain should be considered in posttraumatic headache. We describe two patients with posttraumatic headache who had negative CT scans on initial presentation. One patient later had bilateral subdural hematomas on CT, and the other had temporal lobe hemorrhage on MRI. We recommend considering repeat CT or MRI for persisting posttraumatic headache and mental status change.     

脑静脉血栓的临床特点及影像学表现分析

目的探讨脑静脉血栓(cerebral venous thrombosis,CVT)的临床资料特点、影像学特征及诊断特点。方法回顾性分析30例CVT患者的临床资料特点、影像学表现及诊断特点。结果 (1)30例患者的病因繁杂,分感染性和非感染性两类,感染性相关因素最为常见,占50%。其临床表现复杂且无特异性,主要及首要的症状为头痛。(2)30例CVT患者,经CT、MRI及MRV检查发现累及上矢状窦22例,下矢状窦1例,横窦22例,乙状窦18例,直窦5例,窦汇5例,海绵窦1例,深静脉1例,皮层静脉1例。(3)28例患者进行了CT检查,25例发现异常表现,16例出现索条征、高密度三角征;15例出现脑实质水肿、静脉性脑梗死及合并出血;30例患者均进行了MRI及MRV检查,其中29例MRI检查阳性,表现为CVT形成导致的流空效应的消失,并且出现各时期不同程度的血栓信号,漏诊的1例经MRV检查确诊;30例患者MRV检查均阳性,表现为脑静脉及静脉窦充盈缺损、信号缺失及侧支循环形成。结论CVT病因复杂,发病形式多种多样,临床表现没有特异性。CT、MRI及MRV检查是诊断CVT的无创、准确且敏感的神经影像学技术,其中MRI联合MRV诊断最重要。     

Headache in intracranial hypotension

Abstract We describe the headache characteristics of two patients with intracranial hypotension (IH) and correlate the magnetic resonance imaging (MRI) pattern to the clinical aspects of this type of headache. The first case was that of a patient with spontaneous IH, whereas the second patient had IH following rhinorrhoea. Cerebral computed tomography (CT) performed at presentation of symptoms was normal in both patients. Cerebral MRI in the first case showed meningeal contrast enhancement and an MRI pattern consistent with a subdural hygroma, while in the second case there was only a mild meningeal thickening. The symptoms improved spontaneously in both cases in about 2–3 months, confirming that invasive manoeuvres are not mandatory in these patients.     

Sinus CT scan findings in "sinus headache" migraineurs

OBJECTIVE: To evaluate the sinus CT scan findings in "sinus headache" migraineurs, and to compare the findings to nonmigraine "sinus headache" patients. BACKGROUND: The majority of patients presenting with "sinus headache" satisfy the International Headache Society (IHS) criteria for migraine headache. Few studies have correlated the rhinologic complaints and computed tomography (CT) findings in these patients. METHODS: Thirty-five patients with "sinus headache" were evaluated prospectively and referred for CT of the paranasal sinuses. The CT scans were assessed for sinus abnormality (recorded as a Lund-Mackay [L-M] score) and were analyzed for concha bullosa and septal deviation. The findings in the migraine cohort were compared with the nonmigraine "sinus headache" patients. FINDINGS: Twenty-six patients (74.3%) satisfied the IHS criteria for migraine. The mean CT scan L-M score did not differ significantly between the migraine (2.07) and nonmigraine cohort (2.66). Five of the migraine group had substantial sinus disease radiographically (with L-M scores of 5 or above). Concha bullosa of at least 1 middle turbinate was more common in the nonmigraine cohort. An analysis of the sidedness of the headaches, sinus disease, concha bullosa, and/or septal deviation is presented. CONCLUSIONS: The majority of "sinus headache" patients satisfy the IHS criteria for migraine. Surprisingly, these patients often have radiographic sinus disease. This raises the possibility of selection bias in otolaryngology patients, inaccurate diagnosis, or radiographic sinus disease and migraine as comorbid conditions. Positive migraine histories apparently do not obviate the need for a thorough ENT workup, possibly including CT scanning.     

小脑卒中98例临床分析

目的:分析小脑卒中的发病率、临床特点、影像学诊断及误诊原因。方法:回顾98例小脑卒中患者的临床资料,并分析其症状、体征、发病率、病因、诊断、治疗、预后等。结果:小脑卒中以急性眩晕、头痛、呕吐为主要表现,因缺乏特征表现而易被误诊。头颅CT因受后颅凹伪影干扰而对诊断小脑梗死有一定局限性。MRI成为诊断小脑卒中的有力工具。76例小脑梗死患者经内科治疗,73例好转,3例死亡。22例小脑出血患者经内科治疗,18例好转,2例死亡,2例手术(其中1例好转,1例死亡)。结论:小脑卒中临床表现不典型,易误诊,应及早作CT或MRI检查,早期确诊、早期积极治疗可降低患者病死率。     

垂体卒中的临床及病因分析(附16例报告)

目的：分析垂体卒中的临床、影像学特点及病理生理机制。方法：总结回顾16例垂体卒中临床资料并复习相关文献。结果：81．25％的患者卒中前无垂体瘤病史，大部分无明确诱因，临床表现按出现频率依次为头痛、视力障碍、眼肌麻痹、脑膜刺激征、偏盲、意识障碍及锥体束征；8例行CT检查，7例示垂体瘤；3例发现出血改变；9例MRI检查，8例示垂体瘤出血；13例行手术治疗。所有病例中，仅3例痊愈。结论：垂体卒中临床表现多样，易漏诊或误诊；对突发头痛、视力障碍、眼肌麻痹者应考虑垂体卒中可能，MRI检查阳性率高优于CT扫描。     

TCD评价脑腔隙性梗死的临床意义

目的探讨经颅多普勒(TCD)检查在脑腔隙性梗死中的应用价值。方法对30例经CT、MRI证实为脑腔隙性梗死患者进行TCD检查,并对TCD的表现差异进行分析。结果30例脑腔隙性梗死患者大部分以头痛头昏、肢体麻木就诊,TCD表现为脑血管痉挛,脑供血不足的血流速度改变。结论TCD检查可以明确以不同临床症状就诊的脑腔隙性梗死患者的脑动脉血流动力学改变。     

The forgotten lumbar puncture

Lumbar puncture is crucial in two distinct clinical situations in the diagnosis of the headache patient. The first is the patient who is suspected of having a symptomatic headache; the second is the patient with a chronic intractable or atypical headache disorder. This review discusses the usefulness of the lumbar puncture in the diagnosis of headache secondary to subarachnoid hemorrhage, meningitis, and intracranial hypotension and hypertension. The value of lumbar puncture in the presence of a normal CT/MRI scan is discussed.     

Clues in the Differential Diagnosis of Primary vs Secondary Cough,Exercise, and Sexual Headaches

Activity‐related headaches can be provoked by Valsalva maneuvers (“cough headache”), prolonged exercise (“exertional headache”) and sexual excitation (“sexual headache”). These entities are a challenging diagnostic problem as can be primary or secondary and the etiologies for secondary cases differ depending on the headache type. In this paper we review the clinical clues which help us in the differential diagnosis of patients consulting due to activity‐related headaches. Cough headache is the most common in terms of consultation. Primary cough headache should be suspected in patients older than 50 years, if pain does not predominate in the occipital area, if pain lasts seconds, when there are no other symptoms/signs and if indomethacin relieves the headache attacks. Almost half of cough headaches are secondary, usually to a Chiari type I malformation. Secondary cough headache should be suspected in young people, when pain is occipital and lasts longer than one minute, and especially if there are other symptoms/signs and if there is no response to indomethacin. Every patient with cough headache needs cranio‐cervical MRI. Primary exercise/sexual headaches are more common than secondary, which should be suspected in women especially with one episode, when there are other symptoms/signs, in people older than 40 and if the headache lasts longer than 24 hours. These patients must have quickly a CT and then brain MRI with MRA or an angioCT to exclude space‐occupying lesions or subarachnoid hemorrhage.     

Evaluation of acute headaches in adults

Classifying headaches as primary (migraine, tension-type or cluster) or secondary can facilitate evaluation and management A detailed headache history helps to distinguish among the primary headache disorders. "Red flags" for secondary disorders include sudden onset of headache, onset of headache after 50 years of age, increased frequency or severity of headache, new onset of headache with an underlying medical condition, headache with concomitant systemic illness, focal neurologic signs or symptoms, papilledema and headache subsequent to head trauma. A thorough neurologic examination should be performed, with abnormal findings warranting neuroimaging to rule out intracranial pathology. The preferred imaging modality to rule out hemorrhage is noncontrast computed tomographic (CT) scanning followed by lumbar puncture if the CT scan is normal. Magnetic resonance imaging (MRI) is more expensive than CT scanning and less widely available; however, MRI reveals more detail and is necessary for imaging the posterior fossa. Cerebrospinal fluid (CSF) analysis can help to confirm or rule out hemorrhage, infection, tumor and disorders related to CSF hypertension or hypotension. Referral is appropriate for patients with headaches that are difficult to diagnose, or that worsen or fail to respond to management     

Headaches precipitated by cough,prolonged exercise or sexual activity: a prospective etiological and clinical study

Headaches provoked by cough, prolonged physical exercise and sexual activity have not been studied prospectively, clinically and neuroradiologically. Our aim was to delimitate characteristics, etiology, response to treatment and neuroradiological diagnostic protocol of those patients who consult to a general Neurological Department because of provoked headache. Those patients who consulted due to provoked headaches between 1996 and 2006 were interviewed in depth and followed-up for at least 1 year. Neuroradiological protocol included cranio-cervical MRI for all patients with cough headache and dynamic cerebrospinal functional MRI in secondary cough headache cases. In patients with headache provoked by prolonged physical exercise or/and sexual activity cranial neuroimaging (CT and/or MRI) was performed and, in case of suspicion of subarachnoid bleeding, angioMRI and/or lumbar tap were carried out. A total of 6,412 patients consulted due to headache during the 10 years of the study. The number of patients who had consulted due to any of these headaches is 97 (1.5% of all headaches). Diagnostic distribution was as follows: 68 patients (70.1%) consulted due to cough headache, 11 (11.3%) due to exertional headache and 18 (18.6%) due to sexual headache. A total of 28 patients (41.2%) out of 68 were diagnosed of primary cough headache, while the remaining 40 (58.8%) had secondary cough headache, always due to structural lesions in the posterior fossa, which in most cases was a Chiari type I malformation. In seven patients, cough headache was precipitated by treatment with angiotensin-converting enzyme inhibitors. As compared to the primary variety, secondary cough headache began earlier (average 40 vs. 60 years old), was located posteriorly, lasted longer (5 years vs. 11 months), was associated with posterior fossa symptoms/signs and did not respond to indomethacin. All those patients showed difficulties in the cerebrospinal fluid circulation in the foramen magnum region in the dynamic MRI study and preoperative plateau waves, which disappeared after posterior fossa reconstruction. The mean age at onset for primary headaches provoked by physical exercise and sexual activity began at the same age (40 years old), shared clinical characteristics (bilateral, pulsating) and responded to beta-blockers. Contrary to cough headache, secondary cases are rare and the most frequent etiology was subarachnoid bleeding. In conclusion, these conditions account for a low proportion of headache consultations. These data show the total separation between cough headache versus headache due to physical exercise and sexual activity, confirm that these two latter headaches are clinical variants of the same entity and illustrate the clinical differences between the primary and secondary provoked headaches.     

Thunderclap headache durch Kleinhirninfarkt

Thunderclap headache is an acute and severe headache and is often the first sign of a life-threatening neurovascular disorder. The case of a 44-year-old man is described who presented with a thunderclap headache as the only clinical symptom. The clinical examination did not reveal any other focal deficits or signs of motor or sensory failures. Routine blood tests, cerebral CT as well as cerebrospinal fluid analysis showed no pathological results. A cerebral MRI to exclude a symptomatic thunderclap headache revealed a right cerebellar infarction. This case expands the differential diagnosis of thunderclap headache and reinforces the need for magnetic resonance imaging in the evaluation of such patients, even when neurological examination, cerebral CT, and cerebrospinal fluid analysis are normal.     

Magnetic Resonance Imaging for Recurrent Headache in Childhood and Adolescence

We investigated 429 consecutive patients, aged 5 to 18 (mean: 11.0 ± 3.1) years, diagnosed with migraine or tension-type headache. The patients underwent either MRI or exclusively clinical follow-up examinations. Magnetic resonance imaging revealed normal findings in 82.3% and structural changes in 17.7%. However, the vast majority of these changes had minimal or no pathological relevance, and a causal relationship to the patient's headache could not be proven in any case. In the non-MRI group, clinical follow-up examinations confirmed the initial diagnosis in all patients and MRI was not required in any of these subjects. In conclusion, our study shows a poor relation between recurrent headache fulfilling the criteria of migraine and tension-type headache and structural changes incidentally detected by MRI. In addition, it suggests that clinical follow-up examinations are reliable. Accordingly, MRI is not required for routine examination of recurrent headache in children and adolescents, but it should be performed in patients with abnormal neurological findings, atypical headache pattern, or significant change of preexisting headache.     

鼻咽癌99mTc-MDP SPECT／CT颅底显像阳性的探讨

目的探讨鼻咽癌（NPC）患者头颅SPECT／CT颅底显像阳性的临床意义。方法经病理证实为NPC患者44例（初诊患者30例,复诊14例,低分化鳞癌38例,未分化癌6例,其中患头痛14例）,同期行头颅99mTe-MDP（锝标亚甲基二膦酸盐）SPECT／CT与鼻咽MR显像对比,正常对照组10例行头颅SPECT／CT。于SPECT／CT图像矢状面颅底异常浓集最高计数区域（L）与高位颈椎体（S）处各画相同大小的感兴热区（ROI）,计算L／S值。L／S〉1考虑颅底骨侵犯。结果@SPECT／CT示颅底骨侵犯组（SBBI）24例与未侵犯组（none-SBBI）20例,L/S值分别为1．83±0．69和0．68±0．13,差异显著（P〈0．01）;MRI示24例SBBI和20例none-SBBI,但病例与SPECT／CT不全一致,且SPECT／CT与MRI有一定的相关性②伴头痛患者,SPECT／CT颅底阳性检出率较高（P〈0．01）;低分化鳞癌和未分化癌的阳性检出率无显著差异（P〉0．05）,颅底骨受累部位的多少未见明显影响阳性检出率（P〉0．05）。③对照组L／S〈1。结论NPC患者头颅99Tc-MDPSPECT／CT颅底显像阳性为颅底骨侵犯可能性大,与MRI有较好的相关性。伴头痛患者应高度怀疑颅底骨受肿瘤侵犯,其它影响因素还有待进一步临床研究。     

Headache profile in patients with idiopathic hypertrophic cranial pachymeningitis

BACKGROUND: Idiopathic hypertrophic cranial pachymeningitis (IHCP) is an uncommon disorder due to localized or diffuse thickening of the dura mater. While headache is the most common manifestation, the clinical characteristics of the headache in IHCP have not been well characterized. METHODS: From 1996 to 2002, 6 consecutive patients with IHCP presenting with headache were reviewed (3 women, 3 men; mean age: 49 years). Diagnosis was based on characteristic neuroimaging findings and the exclusion of secondary causes of cranial pachymeningitis. This study reported the headache characteristics, neuroimaging features, and longitudinal follow-up. RESULTS: Chronic daily headache, especially chronic migraine, was the most common headache pattern observed (4/6 patients). Lateralization of headache location appeared to correlate with the distribution of the hypertrophied dural lesions. Diagnostic delay was due to failure to evaluate with gadolinium-enhanced MRI. After treatment, headache (5/6, 83%) and neurologic deficits (2/3, 67%) improved in most patients; however, follow-up MRIs (n = 5) showed deterioration in 3 patients. CONCLUSION: The headache of IHCP is typically a chronic daily headache, often resembling chronic migraine. Correspondingly, IHCP should be considered in the differential diagnosis of refractory chronic daily headache, with or without associated cranial neuropathy or other associated neurologic deficits. The typical imaging finding on gadolinium-enhanced MRI is localized or diffuse pachymeningitis and failure to order a gadolinium-enhanced MRI is the primary reason for delayed diagnosis. Despite symptomatic improvement on longitudinal follow-up, the MRI abnormalities may not improve in parallel with the clinical symptoms.     

Migraine: An Alternative in the Diagnosis of Unclassified Vertigo

SYNOPSIS
Vertigo and unsteadiness are frequent reasons for medical consultation. In some cases, these symptoms remain unclassified. The association of equilibrium disorders with migraine is often mentioned in literature.
Seventy-two cases of unclassified vertigo were studied in order to ascertain the prevalence of migraine in patients affected by recurring episodes of vertigo from undetermined causes, and attempting to establish a possible relationship with migraine. Characteristics of the vertigo and the headache, were evaluated by clinical history and examination, electronystagmogram (ENG), electroencephalogram (EEG), computerized tomography scanning (CT) and/or magnetic resonance imaging (MRI). In the group of patients studied 50% suffered from headache, and 32.8% fulfilled the diagnostic criteria of migraine. Results suggest that only a thorough clinical history would be able to give enough information to establish the diagnosis of migraine in these patients.
These observations imply an alternative diagnosis to be taken into account when a case of unclassified vertigo is evaluated.     

CT联合MRI评估原发性肝癌患者的介入及分子靶向治疗效果

目的探讨CT及MRI评估原发性肝癌（HCC）患者介入及分子靶向治疗效果的价值。方法回顾性选取我院于2017年1月~2019年1月收治的80例中晚期HCC患者作为研究对象,患者均行肝动脉化疗栓塞术（TACE）治疗+索拉非尼治疗,3月后均行CT、MRI和数字减影血管造影（DSA）检查。比较CT联合MRI与单独CT检查HCC患者治疗后3月的临床有效例数、有效率,并以DSA检查结果为金标准,计算两种检查方法的敏感度、特异度、准确率和kappa值,并比较两种检查方法对患者治疗后的残余和复发病灶检出情况。结果经TACE+索拉非尼治疗后3月,DSA显示总目标病灶数由98个减少至86个,病灶明显缩小,临床疾病控制患者64例,无效患者16例,疾病控制率80.00%;共检出残留和复发病灶共82个,其中Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型碘油沉积残留和复发病灶数分别为9、18、42、17个。CT联合MRI检出患者治疗后Ⅱ型以及总碘油沉积残留、复发病灶个数均大于CT检查（P < 0.05）; CT联合MRI评估TACE+索拉非尼治疗HCC患者疗效的灵敏度95.31%高于单独CT检查的84.38%（P < 0.05）,且CT联合MRI评估临床疗效与DSA检查的Kappa值为0.809,且大于单独CT评估与DSA检查的Kappa值（0.605）。结论TACE+索拉非尼治疗HCC患者3月后具有较好的临床疗效,且相比单独CT检查,CT联合MRI更有利于患者治疗后残留和复发灶的检出,同时对于患者治疗后3月疗效的评估具有更高的灵敏度和应用价值。      

以头痛为首发症状的鼻咽癌误诊32例分析

目的探讨以头痛为首发症状的鼻咽癌患者的误诊原因。方法对32例以头痛为首发症状的鼻咽癌患者的临床资料进行分析。结果32例以头痛为首发症状的鼻咽癌患者中有23例（71．87％）合并颅神经损害,容易被误诊为神经系统疾病,而且鼻咽癌的病理类型以浸润型（15／32,46、87％）和黏膜下型（6／32,18、75％）为主,此类患者CT平扫不易发现早期病变,活检时如取材不深不易确诊。结论提高对头痛症状的认识,重视鼻咽部和颅底的影像学检查,以及鼻咽部多次活检可以降低鼻咽癌的误诊。     

脑膜癌病的临床与影像学表现(附8例分析与文献复习)

目的 探讨脑膜癌病的临床特点及影像学表现。并结合文献讨论其早期诊断与治疗。方法 对8例经临床。头颅CT/MRI，脑脊液（CSF）细胞学检查确诊的脑膜癌病患者资料进行综合分析。结果 既有脑症状，又有脑膜刺激征者6例；颅神经损害以后组颅神经，视神经及听神经为主要表现者分别为4例，2例及2例；多组颅神经同时损害4例。脊神经损害2例。CSF细胞学检查均发现癌细胞。早期头颅CT/MRI增强扫描可见脑膜线状与条状异常增强，可有交通性脑积水，脑实质也可有异常强化。6例于3个月内先后死亡。结论 脑膜癌病主要表现为头痛，多组颅神经和（或）脊神经损害及脑膜刺激征。CT/MRI对脑膜癌病的早期诊断有重要意义。且MRI优于CT，CSF发现癌细胞仍是确诊脑膜癌病最简便与最直接的证据。     

X线平片、CT及MRI在强直性脊柱炎骶髂关节病变诊断中的应用价值

目的探讨X线平片、计算机断层扫描(CT)及磁共振成像(MRI)在强直性脊柱炎骶髂关节病变诊断中的应用价值。方法选取2015年8月至2019年12月我院收治的57例强直性脊柱炎患者作为研究对象,均行X线平片、CT及MRI检查。以ASAS临床诊断为金标准,比较X线平片、CT、MRI对强直性脊柱炎患者骶髂关节病变的诊断结果。结果57例强直性脊柱炎患者中,43例发生骶髂关节病变。MRI对强直性脊柱炎患者骶髂关节病变的诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值高于X线平片与CT(P<0.05);CT对强直性脊柱炎患者骶髂关节病变的诊断灵敏度、特异度、准确度、阴性预测值高于X线平片(P<0.05)。MRI对Ⅰ级、Ⅱ级骶髂关节病变的诊断符合率高于X线平片与CT(P<0.05)。MRI对关节面侵蚀、关节面下骨质囊变、关节软骨囊肿的诊断符合率高于X线平片与CT(P<0.05)。结论在强直性脊柱炎患者骶髂关节病变诊断中,MRI的诊断准确性优于X线平片和CT,其不仅能够有效检出骶髂关节病变,而且能对不同分级、不同类型骶髂关节病变进行鉴别。