Schwedt Todd J, Guo Yifan, Rothner A David
Department of Neurology, Cleveland Clinic Foundation, OH 44195, USA.
Headache. 2006 Mar;46(3):387-98. doi: 10.1111/j.1526-4610.2006.00371.x.
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.
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.
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.
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.
研究头痛儿童脑部影像学检查中“良性”异常的发生率，将其与决定患者治疗方案改变的影像学检查结果的发生率进行比较，并确定良性检查结果与头痛之间的关联。
回顾了一个来自儿科门诊神经科的681例头痛患者的数据库，该数据库涵盖了两年时间。将有良性影像学异常的患者与有非良性检查结果的患者进行比较。良性异常被定义为那些不会导致患者治疗方案改变的异常。通过文献综述，我们讨论了良性检查结果及其与头痛可能的关联。
241例患者（35.4%）在我们机构进行了影像学检查。218例进行了脑部磁共振成像，23例仅进行了脑部计算机断层扫描（CT）。22例患者除脑部成像外还进行了鼻窦CT检查。46例（19.1%）被发现有50种良性异常，包括13例鼻窦疾病、11例Chiari I型畸形、7例非特异性白质异常、5例静脉血管瘤、5例蛛网膜囊肿、4例扩大的Virchow-Robin间隙、2例松果体囊肿、1例巨大枕大池、1例基底动脉近端开窗和1例脑室周围白质软化。23例患者（9.5%）的检查结果需要改变治疗方案。这些包括5例鼻窦疾病、4例肿瘤、4例陈旧性梗死、3例Chiari I型畸形、2例烟雾病、1例颅内血管狭窄、1例颈内静脉闭塞、1例动静脉畸形、1例脱髓鞘疾病和1例脑出血。排除在影像学检查前临床已明确的鼻窦炎后，3例患者没有异常的神经症状和体征，但影像学检查结果导致了治疗方案的改变。
在进行脑部影像学检查的儿童头痛患者中，约20%有良性异常，这些异常不会导致头痛治疗方案的改变。在没有异常神经症状和体征的患者中，需要改变治疗方案的影像学检查结果很少见，在本研究中进行影像学检查的患者中发生率为1.2%。
