imaging headache final 111008

8/14/2019 Imaging Headache Final 111008

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Prof.M.Tameem AkhtarD i r e c t o r , D e p t t o f R a d i o l o g y

D r . Z i a u d d i n U n i v e r s i t yK a r a c h i

ImagingImaging

HeadacheHeadache


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80% people have HAs ?? types 40% severe & disabling

Only 5% present to a doctor for help

Of pts presenting in ED, 10% have 2 causes: -- of these:Aneurysm: 2 - 5%

Brain tumour: 1%

A/V malformation: 0.8%

HeadacheHeadache


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4CAUSESCAUSES


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Primary causes:

Tension headache ------ 90%

Migraine ----- 2nd most common

Cluster Headaches very severe but more

unusual

Radiolo , little role to la , ?? exclusionalRadiolo , little role to pla , ?? exclusional

Common Causes of headacheCommon Causes of headache


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Secondary2. Sinusitis3. Dental, TMJ abnormalities4. Neck anomalies5. Post concussion6. Trigeminal neuralgia7. Hypertension

8. Viral infections colds, influenza9. Alcohol withdrawal hangover10. Dehydration

Radiolo , direct, s ecific, exclusional, roleRadiolo , direct, specific, exclusional, role

Common Causes of headacheCommon Causes of headache


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Cerebral abscess Cerebral tumour Intracranial haematoma

Subdural/ Epidural/ Extradural

Meningitis

Aneurysm Arteritis

Radiolo , essential... CT or MRIRadiolo , essential... CT or MRI

Other causes of headacheOther causes of headache


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DONT FORGET BABIES:

1. Ischemia2. Haemorrhage

3. Mass

4. Developmental

Radiology, US in 1Radiology, US in 1stst instance ... CT scan or MRI later oninstance ... CT scan or MRI later on

Causes of headache in kidsCauses of headache in kids


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RADIOLOGICALRADIOLOGICALInvestigation techniquesInvestigation techniques


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Plain X-ray >>> role??

Angio therapeutic; embolization

CROSS SECTIONAL

CT / MDCT/ CTA/ 3D

MRI/MRA/MRV

US (infant)

Investigation techniquesInvestigation techniques


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ULTRASOUNULTRASOUN


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Pre-natal & neonatal neurology screening

Definitive in infants:

1. ICH

2. HIE

3. Infection

4. Developmental malformations of brain5. SOL

US choiceUS choice


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AdvantagesAdvantages DisadvantagesDisadvantages

1. Non-invasive.2. Inexpensive.

3. Portable.

4. Fast.

5. Multiplanar.

6. No contrast agents.

7. No sedation ??.

1. Cranial exams limitedto infants.

2. Operator dependent.

3. View limited by probe

size.4. Needs a window.

5. Artefacts can mimic apathology.

ULTRASOUNDULTRASOUND


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US superior to CT.

CT for extracerebral hge SAH / SDH.CT for posterior fossa collections.

MRI superior to all CT applications.

some problems in early neonatal period.

Neonates: US vs otherNeonates: US vs otherNeuro-imagingNeuro-imaging


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CTCT


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1. Acute trauma.

2. Acute hge.

3. Infection.

4. Infarction/Stroke.

5. Malformations.

6. Atrophy.

7. Hydrocephalus.8. Skull lesions.

9. Calcified lesions.

10. Orbits, sinuses, petrous bones.

CT is of choiceCT is of choice


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CT


1. Fast

2. Easily accessible mosthospitals in emergencies

3. Fine bone resolution

4. Modern scanners

multiplanar imaging?? Orbits

Sinuses

TMJs

Sellar masses

1. Radiation dose !

2. Sedation in restless pts &

young children

3. I.V. contrast risks

4. Not portable

5. Metallic artefacts due to

beam hardening

surgical clips


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MRIMRI


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1. Brain maturation2. Encephalitis3. Vasculitis4. Small lesions:

1. abscesses,2. trauma (NAI)

5. Tumours:1. Aqueduct.2. Brainstem.3. Pituitary.

6. Neurodegenerativediseases.

7. Neuromigratorydisorders.

8. Infarction, early detection

9. AVMs.10. Myelination.

MRI indicationsMRI indications


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1. Versatile2. Non-ionising radiation

3. Non-invasive

4. Multi-planar

5. High resolution

MRIMRI

1. Slower2. Motion sensitive3. Claustrophobia ?

Open magnet4. Sedation for children &

anxious adults

5. Difficult access emergency & ICU

6. Expensive???


C l i


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Neuro-imaging useful to identify astructural lesion

Tests should be avoided if they will

not lead to a change in management;

ConclusioConclusio


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PNS XPNS X


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PNS X-PNS X-

SinusitisSinusitis


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SinusitisSinusitis


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26CholesteatomaCholesteatoma

AA


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AneurysmAneurysm

CTACTA


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CTACTA

A / b liA / b li


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Aneurysm/embolismAneurysm/embolism

A l i f B iA l i f B i


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Age of pt. Localization

Intra vs extra-axialWhat compartmentMid line crossing

CT & MR characteristics:Calcifications, fat, cysticT1, T2, DWI

Contrast enhancementMass effect edemaSolitary MultiplePseudo-tumour ?

Analysis of BrainAnalysis of Brain

Sk llSkull XX


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SkullSkull X-X-

Acoustic NeuromaAcoustic Neuroma


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MeningioMeningio


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SOSO


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SOSO


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Ring enhancingRing enhancing

SOLSOL


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SOLSOL

SOSO


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SOSO

SOLSOL


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SOLSOL


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OBSTRUCTIVEOBSTRUCTIVE


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OBSTRUCTIVEOBSTRUCTIVE


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SAHSAHSAH

STROKSTROK

SAHSAH


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SAHSAH


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STROKSTROK


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SAH

STROKSTROK

STROKSTROK


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STROKSTROK

SDHSDH


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SDHSDH


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47BONY METSBONY METS

SummarySummary


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Most HAs will be 1, but mustrecognize the Red Flags of serious2 HA.

Use of correct modality..

SummarySummary


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imaging headache final 111008

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