Imarhiagbe Frank Aiwansoba, Ogbeide Ehi
Department of Medicine, University of Benin, Benin City, Nigeria.
Ann Afr Med. 2011 Oct-Dec;10(4):290-3. doi: 10.4103/1596-3519.87046.
Headache is a common complaint in general practice and it is known that most headaches are primary and that the yield of neuroimaging like cranial computed tomography (CT) in headache is generally low. In this study, we were able to demonstrate that the yield of neuroimaging in non-acute and recurrent headache could be higher if cases are reviewed first by a specialist Neurologist before cranial CT.
Seventy-four cases that were referred to the specialist neurology clinic with complaints of chronic and recurrent headaches without focal neurological deficit that had CT scan were reviewed consecutively using the short form of the International Classification of Headache Disorders second edition (ICHD 2) criteria after their demographics of age, sex were captured, to find out the proportion and characteristics of study cases that had identifiable cranial lesions on cranial CT scan. All cases were reviewed by a specialist Neurologist before CT scan and all CT films were reviewed by a specialist Radiologist. Age, sex and the distribution of CT findings were described from a frequency table and mean age of study cases with and without identifiable lesions on CT were compared with t-test for any significant difference and the effect of gender on the presence of identifiable lesions was tested with chi square and the agreement between clinical and CT diagnoses were tested on kappa statistics.
(1) Mean age of cases was 37.55 (22.06) years. (2) No significant effect of gender was found on intracranial lesions (P = 0.345). (3) Intracranial lesions were found in 47.3% of cases and the mean age was higher compared to cases with normal findings on cranial CT (P = 0.019). (4) Clinical and CT diagnoses agreed in 56.2% of the cases (P = 0.000).
The high yield of intracranial lesions may be accounted for by the method of selection of cases for cranial CT.
头痛是全科医疗中常见的主诉，已知大多数头痛为原发性，且头颅计算机断层扫描（CT）等神经影像学检查在头痛诊断中的阳性率通常较低。在本研究中，我们能够证明，如果在进行头颅CT检查之前先由神经科专科医生对病例进行评估，那么在非急性复发性头痛中神经影像学检查的阳性率可能会更高。
连续审查74例因慢性复发性头痛而无局灶性神经功能缺损且接受过CT扫描的病例，这些病例被转诊至神经科专科门诊。在记录年龄、性别等人口统计学信息后，使用《国际头痛疾病分类第二版》（ICHD - 2）标准简表进行评估，以确定头颅CT扫描中可识别的颅内病变的病例比例和特征。所有病例在CT扫描前均由神经科专科医生进行评估，所有CT片均由放射科专科医生进行审查。通过频率表描述年龄、性别及CT检查结果的分布情况，采用t检验比较CT检查有或无可识别病变的研究病例的平均年龄，以确定是否存在显著差异；采用卡方检验检测性别对可识别病变存在情况的影响；采用kappa统计检验临床诊断与CT诊断之间的一致性。
（1）病例的平均年龄为37.55（22.06）岁。（2）未发现性别对颅内病变有显著影响（P = 0.345）。（3）47.3%的病例发现有颅内病变，与头颅CT检查结果正常的病例相比，其平均年龄更高（P = 0.019）。（4）56.2%的病例临床诊断与CT诊断一致（P = 0.000）。
颅内病变的高阳性率可能与头颅CT病例的选择方法有关。
