Vallamkondu V, Shakeel M, Hussain A, McAteer D
Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen AB252ZN, UK.
Case Rep Otolaryngol. 2013;2013:735147. doi: 10.1155/2013/735147. Epub 2013 Feb 28.
Headache is a common symptom, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations. Neuroimaging is indicated in patients with red flag features for secondary headaches. The guidelines recommend CT or MRI scan to identify any intracranial pathology. We present a unique case where the initial noncontrast CT scan failed to identify a potential treatable cause for headache. A middle aged man presented with headache and underwent a CT scan without contrast enhancement. The scan was reported as normal. The headache persisted for years and the patient underwent a staging CT scan to investigate an oropharyngeal cancer. This repeat CT scan utilized contrast enhancement and revealed a meningioma. Along with other symptoms, headache is an established presenting complaint in patients with meningioma. The contrast enhanced CT brain proved superior to a nonenhanced CT scan in identifying the meningioma. In a patient with persistent headache where other causes are excluded and a scan is to be requested, perhaps contrast enhanced CT is a better option than a plain CT scan of brain.
头痛是一种常见症状，在英国普通人群中的终生患病率超过90%。它占基层医疗咨询的4.4%，占神经内科门诊咨询的30%。具有继发性头痛红旗特征的患者需要进行神经影像学检查。指南推荐进行CT或MRI扫描以识别任何颅内病变。我们呈现了一个独特的病例，最初的非增强CT扫描未能识别出头痛的潜在可治疗病因。一名中年男性因头痛就诊并接受了无对比增强的CT扫描。扫描结果报告为正常。头痛持续了数年，患者接受了分期CT扫描以排查口咽癌。这次重复CT扫描使用了对比增强，结果发现了一个脑膜瘤。除其他症状外，头痛是脑膜瘤患者既定的主诉症状。增强CT脑扫描在识别脑膜瘤方面优于非增强CT扫描。对于患有持续性头痛且已排除其他病因并需要进行扫描的患者，或许增强CT比普通脑部CT扫描是更好的选择。
