"Benign" imaging abnormalities in children and adolescents with headache

Todd J Schwedt, Yifan Guo, A. David Rothner

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Objective. - To study the frequency of "benign" abnormalities on brain imaging in children with headache, compare it with the frequency of imaging findings that dictate a change in patient management, and determine the association of benign findings with headache. Methods. - A database of 681 headache patients from the pediatric outpatient neurology department over 2 years was reviewed. Patients with benign imaging abnormalities were compared to those with nonbenign findings. Benign abnormalities were defined as those that did not result in a change in patient management. Using literature review, we discuss the benign findings and their possible association with headache. Results. - Two-hundred and forty-one patients (35.4%) had imaging at our facility. Two-hundred and eighteen had brain magnetic resonance imaging and 23 had brain computed tomography (CT) only. Twenty-two patients had CT of the sinuses in addition to brain imaging. Forty-six (19.1%) were found to have 50 benign abnormalities including 13 sinus disease, 11 Chiari I malformations, 7 nonspecific white matter abnormalities, 5 venous angiomas, 5 arachnoid cysts, 4 enlarged Virchow-Robin spaces, 2 pineal cysts, 1 mega cisterna magna, 1 fenestration of the proximal basilar artery, and 1 periventricular leukomalacia. Twenty-three patients (9.5%) had findings requiring a change in management. These included 5 sinus disease, 4 tumors, 4 old infarcts, 3 Chiari I, 2 moyamoya, 1 intracranial vascular stenosis, 1 internal jugular vein occlusion, 1 arteriovenous malformation, 1 demyelinating disease, and 1 intracerebral hemorrhage. When excluding sinusitis, which was evident clinically prior to imaging, 3 patients had absence of abnormal neurologic symptoms and signs and imaging findings that resulted in a change in management. Conclusions. - Approximately 20% of pediatric headache patients with brain imaging have benign abnormalities that do not result in a change in headache management. Imaging findings that require a change in management are rare in patients with an absence of abnormal neurologic symptoms and signs, occurring in 1.2% of patients imaged in this study.

Original languageEnglish (US)
Pages (from-to)387-398
Number of pages12
JournalHeadache
Volume46
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

Fingerprint

Headache
Neuroimaging
Neurologic Manifestations
Tomography
Periventricular Leukomalacia
Pediatrics
Cisterna Magna
Arachnoid Cysts
Basilar Artery
Songbirds
Arteriovenous Malformations
Sinusitis
Jugular Veins
Cerebral Hemorrhage
Brain
Demyelinating Diseases
Hemangioma
Neurology
Blood Vessels
Cysts

Keywords

  • Arachnoid cysts
  • Arnold-Chiari malformation
  • Headache
  • Magnetic resonance imaging
  • Migraine
  • Sinusitis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

"Benign" imaging abnormalities in children and adolescents with headache. / Schwedt, Todd J; Guo, Yifan; Rothner, A. David.

In: Headache, Vol. 46, No. 3, 03.2006, p. 387-398.

Research output: Contribution to journalArticle

Schwedt, Todd J ; Guo, Yifan ; Rothner, A. David. / "Benign" imaging abnormalities in children and adolescents with headache. In: Headache. 2006 ; Vol. 46, No. 3. pp. 387-398.
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abstract = "Objective. - To study the frequency of {"}benign{"} abnormalities on brain imaging in children with headache, compare it with the frequency of imaging findings that dictate a change in patient management, and determine the association of benign findings with headache. Methods. - A database of 681 headache patients from the pediatric outpatient neurology department over 2 years was reviewed. Patients with benign imaging abnormalities were compared to those with nonbenign findings. Benign abnormalities were defined as those that did not result in a change in patient management. Using literature review, we discuss the benign findings and their possible association with headache. Results. - Two-hundred and forty-one patients (35.4{\%}) had imaging at our facility. Two-hundred and eighteen had brain magnetic resonance imaging and 23 had brain computed tomography (CT) only. Twenty-two patients had CT of the sinuses in addition to brain imaging. Forty-six (19.1{\%}) were found to have 50 benign abnormalities including 13 sinus disease, 11 Chiari I malformations, 7 nonspecific white matter abnormalities, 5 venous angiomas, 5 arachnoid cysts, 4 enlarged Virchow-Robin spaces, 2 pineal cysts, 1 mega cisterna magna, 1 fenestration of the proximal basilar artery, and 1 periventricular leukomalacia. Twenty-three patients (9.5{\%}) had findings requiring a change in management. These included 5 sinus disease, 4 tumors, 4 old infarcts, 3 Chiari I, 2 moyamoya, 1 intracranial vascular stenosis, 1 internal jugular vein occlusion, 1 arteriovenous malformation, 1 demyelinating disease, and 1 intracerebral hemorrhage. When excluding sinusitis, which was evident clinically prior to imaging, 3 patients had absence of abnormal neurologic symptoms and signs and imaging findings that resulted in a change in management. Conclusions. - Approximately 20{\%} of pediatric headache patients with brain imaging have benign abnormalities that do not result in a change in headache management. Imaging findings that require a change in management are rare in patients with an absence of abnormal neurologic symptoms and signs, occurring in 1.2{\%} of patients imaged in this study.",
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