Abnormalites of Brain Computed Tomographic Scan and Magnetic Resonance Imaging in Headache Patients with Normal Neurologic Examination

Abstract

Eventhough the brain computed tomography (CT) scan and brain magnetic resonance imaging (MRI) are recognized as important techniques for evaluating the dangerous headache patients such as those with subarachnoid hemorrhage or brain tumor, the value of those imaging studies in headache patients with normal neurological examination is not well established in Korea. From the data of the studies done in other countries, the abnormal findings are detected by brain CT or MRI studies in about 3 % of headache patients with normal neurological examination.

In order to investigate the abnormal findings detected by brain CT or MRI in headache patients with normal neurological examination, we evaluated 332 headache patients who did not show any obvious abnormality on neurological examination and performed brain CT scan (264 patients) or MRI (68 patients) studies. Among 264 patients studied with brain CT, 7(2.7 %) showed symptomrelated abnormalities(3 subdural hematomas, 1 arteriovenous malformation, 1 venous sinus thrombosis, 1 obstructive hydrocephalus) while 11(4.2%) were revealing abnormal findings not related with headache (6 cortical atrophies, 5 old strokes). Three (4.4 %) of 68 patients with MRI revealed symptom-related abnormal findings (1 ganglioglioma, 1 pituitary adenoma, 1 metastatic tumor) while 5 patients (7.4 %) were showing abnormalities unrelated with headache (3 old strokes, 1 cortical atrophy, 1 venous angioma). Total occurrence rate of abnormal findings, whether symptom-related or not, in either brain C, T or MRI was 7.8 %. By either brain CT scan or MRI, symptom-related abnormalities requiring specific management were found in 3.0 %.

We conclude that even in those headache patients without any obvious abnormality on neurological examination brain CT scan or MRI may play a valuable role.