Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylul University Hospital, Izmir, Turkey.
Headache. 2013 Jun;53(6):970-6. doi: 10.1111/head.12089. Epub 2013 Apr 1.
We aimed to describe the prevalence and significance of white matter lesions detected on magnetic resonance imaging (MRI) in children with headache.
Children who were admitted with the complaint of headache and had neuroimaging between December 2007 and June 2012 were included in the study. The clinical and neuroimaging data of the patients were retrospectively evaluated. MRI results of the patients were documented in detail. The patients with non-specific white matter lesions were called for a control visit, and current status of headache and neurological findings were determined.
A total of 941 patients were included in the study. Sixty-one percent of the patients received cranial neuroimaging. 8.2% had only cranial computed tomography (CT), 7.5% had cranial CT and cranial MRI, and 84.3% had only cranial MRI. 22.1% of the patients had abnormal cranial MRI findings. The rate of incidental non-specific white matter changes detected in our study group was 23/527 (4.4%). Among the 23 patients, 12 (52.2%) were male and 11 (47.8%) were female. Fourteen (60.9%) had migraine without aura, 8 (34.8%) had tension-type headache, and 1 (4.3%) had migraine with aura. Mean age of patients at the time of imaging was 12.1 ± 3.4 years (range 4.0-16.0 years). All patients with non-specific white matter changes on MRI showed normal psychomotor development, and there was no history of seizures or head trauma. The physical and neurological examinations of all patients were normal. The mean clinical follow-up period of the patients was 16.8 ± 17.3 months (range 6-80 months). No patients showed neurological deterioration during the follow up. The white matter lesions were supratentorial in all patients. The mean size of the lesions was 5.1 ± 4.5 mm (minimum, 2 mm; maximum, 24 mm). Repeated radiological evaluations were performed in 11 (47.8%) of the patients. No new white matter lesions were detected in control MRI during follow up.
Non-specific incidental white matter changes may be seen in children with headache. For normal clinical follow up, in the absence of evident benefits from repeated imaging studies, we suggest that repeated imaging studies are not warranted in every patient and should be tailored according to clinical course.
描述头痛患儿磁共振成像（MRI）检查发现的脑白质病变的发生率和意义。
回顾性分析 2007 年 12 月至 2012 年 6 月期间因头痛就诊并接受神经影像学检查的患儿的临床和神经影像学资料。详细记录患者 MRI 结果。对存在非特异性脑白质病变的患者进行随访，评估头痛现状和神经学发现。
本研究共纳入 941 例患儿。61%的患儿接受了颅部神经影像学检查。8.2%仅行颅脑 CT（CT）检查，7.5%行颅脑 CT 和颅脑 MRI 检查，84.3%仅行颅脑 MRI 检查。22.1%的患儿颅脑 MRI 检查结果异常。本研究组偶然发现的非特异性脑白质改变发生率为 23/527（4.4%）。在这 23 例患者中，12 例（52.2%）为男性，11 例（47.8%）为女性。14 例（60.9%）为无先兆偏头痛，8 例（34.8%）为紧张型头痛，1 例（4.3%）为有先兆偏头痛。影像学检查时患者的平均年龄为 12.1±3.4 岁（4.0-16.0 岁）。MRI 上存在非特异性脑白质改变的所有患者精神运动发育均正常，且无癫痫发作或头部外伤史。所有患者的体格检查和神经检查均正常。患者的平均临床随访时间为 16.8±17.3 个月（6-80 个月）。随访期间，无患者出现神经功能恶化。所有患者的脑白质病变均位于幕上，病变平均大小为 5.1±4.5mm（最小 2mm，最大 24mm）。11 例（47.8%）患者重复了影像学检查。在随访期间的 MRI 中，未发现新的脑白质病变。
头痛患儿可能出现非特异性偶然脑白质改变。对于正常的临床随访，如果重复影像学检查无明显获益，我们建议并非所有患者都需要重复影像学检查，应根据临床病程量身定制。
