Abstract
Requesting a neuro image in a patient suffering from headache is a daily challenge for neurologists in the setting of emergencies and in the attention of ambulatory patients. This decision process must be supported by scientific and clinical judgment; nevertheless, there are some additional factors that influence the final conduct. Part of these factors is represented by regulation processes established by entities in charge of health promotion in our country (EPS-entidades promotoras de salud) and in many cases by the anxiety feeling of patients who want to rule out the existence of dangerous diseases specially tumors and aneurisms.
These former factors influence usually in a negative way the cost-benefit relation of the attention health processes. Other factor that must be taken into account in this setting is the high probability of incidental findings that finally will guide to unnecessary medical and surgical interventions, increasing cost and complications for patients and health system.
In spite of the previous reasoning it is possible to consider, from a different point of view, that the existence of normal neuro images improve the treatment compliance and decrease the anxiety of patients obtaining better results in the outcome of primary headaches.
References
- Alper F, Kantarci M, Dane S, et al. Importance of anatomical asymmetries of transverse sinuses: an MR venographic study. Cerebrovascular Dis 2004;18:236-239.
- Armao D, Castillo M, Chen H, Kwock L. Colloid cyst of the third ventricle: imaging pathologic correlation. AJNR Am J Neuroradiol 2000;21:1470-1477.
- Arnett BC. Tonsillar ectopia and headaches. Neurol Clin 2004;22:229-236.
- Bakshi R, Shaikh ZA, Kamran S, Kinkel PR. MRI findings in 32 consecutive lipomas usingconventional and advanced sequences. J Neuroimaging 1999;9:134-140.
- Binder DK, Horton JC, Lawton MT, McDermott MW. Idiopathic intracranial hypertension. Neurosurgery 2004;54:538-551.
- Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007;357:2277-2284.
- Bowyer SM, Aurora KS, Moran JE, Tepley N, Welch KM. Magnetoencephalographic fields from patients with spontaneous and induced migraine aura. Ann Neurol 2001;50:582-7.
- Broome DR, Girguis MS, Baron PW, et al. Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned. AJR Am J Roentgenol 2007;188(2):586-592.
- Cady RK, Dodick DW, Levine HL, et al. Sinus headache: a neurology, otolaryngology, allergy, and primary care consensus on diagnosis and treatment. Mayo Clin Proc 2005;80:908-916.
- Castillo M, Morrison T, Shaw JA, Bouldin TW. MR imaging and histologic features of capillary telangiectasia of the basal ganglia. AJNR Am J Neuroradiol 2001;22:1553-1555.
- Cumurciuc R, Crassard I, Sarov M, et al. Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases. J Neurol Neurosurg Psychiatry 2005;76:1084-1087.
- De Benedittis G, Lorenzetti A, Sina C, Bernasconi V. Magnetic resonance imaging in migraine and tension-type headache. Headache 1995;35:264-8.
- Epelman M, Daneman A, Blaser SI, et al. Differential diagnosis of intracranial cystic lesion at head US: correlation with CT and MRI. Radiographics 2006;26:173-196.
- Evans RW, Rozen TD, Mechtler LL. Neuroimaging and other diagnostic testing in headache. In: Silberstein SD, Lipton RB, Dodick DW, editors. Wolff ’s headache and other head pain. 8th ed. New York: Oxford University Press, 2007.
- Farb RI, Forghani R, Lee SK, et al. The venous distention sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain. AJNR Am J Neuroradiol 2007;28(8):1489-1493.
- Friedman DI. Pseudotumor cerebri. Neurol Clin 2004;22(1):99-131. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia 2004;24(suppl 1):9-160.
- Hellwig D, Bauer BL, Shulte M, et al. Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade. Neurosurgery 2003;52:525-533.
- Hofkes SK, Iskandar BJ, Turski PA, et al. Differentiation between symptomatic Chiari I malformation and asymptomatic tonsilar ectopia by using cerebrospinal fluid flow imaging: initial estimate of imaging accuracy. Radiology 2007;245:532-540.
- Horton SC, Bunch TJ. Patent foramen ovale and stroke [published erratum appears in Mayo Clin Proc 2004;79:279]. Mayo Clin Proc 2004;79:79-88.
Idbaih A, Boukobza M, Crassard I. MRI of clot in cerebral venous thrombosis: high diagnostic value of susceptibility-weighted images. Stroke 2006;37:991-995.
- Kan P, Stevens EA, Couldwell WT. Incidental giant arachnoid granulation. AJNR Am J Neuroradiol 2006;27:1491-1492.
- Kaufmann P, Shungu DC, Sano MC, et al. Cerebral lactic acidosis correlated with neurological impairment in MELAS. Neurology 2004;62:1297-1302.
- Kim BS. Incidental findings on pediatric MRI images of the brain. AJNR Am J Neuroradiol 2002;23:1674-1677.
- Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Brain stem and cerebellar hyperintense lesions in migraine. Stroke 2006;37:1109-1112.
- Kruit MC, van Buchem MA, Hofman PA, et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004;291:427-434.
- Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics 2006;26(suppl 1):19-41.
- Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002;59:490-498.
- Markus HS, Martin RJ, Simpson MA, et al. Diagnostic strategies in CADASIL. Neurology 2002;59:1134-1138.
- Matharu MS, Bartsch T, Ward N, Frackowiak RS, Weiner R, Goadsby PJ. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 2004;127(Pt 1):220-30
- May A, Kaube H, Buchel C, et al. Experimental cranial pain elicited by capsaicin: a PET study. Pain 1998b;74:61-6.
- Mazzotta G, Floridi F, Mattioni A, et al. The role of neuroimaging in the diagnosis of headache in childhood and adolescence: a multicentre study. Neurol Sci 2004;25(suppl 3):265-266.
- Mechtler L. Role of neuroimaging in our understanding of the pathogenesis of primary headaches. Curr Pain Headache Rep 2004;8(5):404-409.
- Mechtler LL. Pain due to tumors of the skull base. In: de Leon-Casasola OA, ed. Cancer pain: pharmacologic, interventional, and palliative approaches. Philadelphia: Saunders, 2007:55-68.
- Mechtler LL, Stiles MA. Secondary headaches. In: Silberstein SD, Stiles MA, Young WB, editors. Atlas of migraine and other headaches. 2nd ed. Boca Raton, FL: Taylor & Francis, 2005:99-133.
- Medina J, Pinter J, Zurakowski D, et al. Children with headache: clinical predictors of surgical space- occupying lesions and the role of neuroimaging. Radiology 1997;202:819.
- Mokri B. Low cerebrospinal fluid pressure syndromes.
Neurol Clin 2004;22:55-74.
- Moody MW, Chi DH, Mason JC, et al. Tornwaldt’s cyst: incidence and a case report [published erratum appears in Ear Nose Throat J 2007;86:129]. Ear Nose Throat J 2007;.86:45- 47, 52.
- Olesen J, Friberg L, Olsen TS, et al. Timing and topography of cerebral blood flow, aura, and headache during migraine attacks. Ann Neurol 1990;28:791-8.
- Olesen J, Larsen B, Lauritzen M. Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine. Ann Neurol 1981a;9:344-52.
- Olesen J, Tfelt-Hansen P, Henriksen L, Larsen B. The common migraine attack may not be initiated by cerebral ischaemia. Lancet 1981b;2:438-40.
- Osborn AG, Preece MT. Intracranial cysts: radiologic- pathologic correlation and imaging approach. Radiology 2006;239:650-664.
- Pesa J, Lage MJ. The medical costs of migraine and comorbid anxiety and depression. Headache 2004;44:562-570.
- Pu Y, Mahankali S, Hou J, et al. High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging. AJNR Am J Neuroradiol 2007;28:1706-1709.
- Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: the utility of neuroimaging in the evaluation of headache in patients with normal neurologic examinations (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1994;44:1353-1354.
- Ramírez SF, Sanin LC, Takeuchi Y. Cefalea en urgencias. Cefalea y Dolor Craneofacial. McGraw Hill Interamericana. 2000: 265-278.
- Ramírez SF, Urrea E. Diagnóstico y Tratamiento de la Cefalea. Guia Neurológica. Exlibris Editores S.A. 1999:127-141.
- Ramírez SF. Cefalea en salvas y otras cefaleas paroxísticas.
Cefalea Hoy 2001 1: 1-25.
- Ramírez SF. Disección Carotídea. Cefalea y Dolor Craneofacial. McGraw Hill Interamericana. 2000: 330-336.
- Rocca MA, Ceccarelli A, Falini A, et al. Brain gray matter changes in migraine patients with T2-visible lesions: a 3-T MRI study. Stroke 2006;37:1765-1770.
- Rocca MA, Colombo B, Inglese M, Codella M, Comi G, Filippi M. A diffusion tensor magnetic resonance imaging study of brain tissue from patients with migraine. J Neurol Neurosurg and Psych 2003a;74:501-4.
- Rocca MA, Colombo B, Pagani E, et al. Evidence for cortical funcitonal changes in patients with migraine and white matter abnormalities on conventional and diffusion tensor magnetic resonance imaging. Stroke 2003b;34:665-70.
- Rocca MA, Colombo B, Pratesi A, et al. A magnetization transfer imaging study of the brain in patients with migraine. Neurology 2000;54:507-12.
- Sanchez del Rio M, Bakker D, Wu O, et al. Perfusion weighted imaging during migraine: spontaneous visual aura and headache. Cephalalgia 1999;19:701-7.
- Sanchez del Rio M. Cooke LL, Becker WJ. Neuroimaging of headache. In: Menkink of Nerology 2007.
- Sanchez del Rio M. Cooke LL, Becker WJ. Functional neuroimaging in primary headache desorders . In: Menkink of Nerology. 2006.
- Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006; 295:2286-2296.
- Sempere AP, Porta-Etessam J, Medrano V, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia 2005;25:30 -35.
- Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology [published erratum appears in Neurology 2000;56(1):142]. Neurology 2000;26;55:754-762.
- Silberstein SD. Headaches due to nasal and paranasal sinus disease. Neurol Clin 2004; 22:1-19.
- Spencer MP, Moehring MA, Jesurum J, et at. Power m-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure. J Neuroimaging 2004;14:342-349.
- Swartz RH, Kern RZ. Migraine is associated with magnetic resonance imaging white matter abnormalities: a meta-analysis. Arch Neurol 2004;61:1366-1368.
- Vernooij MW, Ikram MA, Tanghe HL. Incidental findings on brain MRI in the general population. N Engl J Med 2007;357;1821-1828.
- Wang HZ, Simonson TM, Greco WR, Yuh WT. Brain MRI in the evaluation of chronic headache in patients without other neurological symptoms. Acad Radiol 2001;8:405-408.
- Weiller C, May A, Limmroth V, et al. Brain stem activation in human migraine attacks. Nature Med 1995;1:658-60.
- Welch KM, Nagesh V, Aurora SK, Gelman N. Periaqueductal gray matter dysfunction in migraine: cause or the burden of illness? Headache 2001;41:629-637.
- Woods RP, Iacoboni M, Mazziotta JC. Brief report: bilateral spreading cerebral hypoperfusion during spontaneous migraine headache. N Engl J Med 1994;331:1689-92.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.