Goldstein Lilach, Laytman Tamar, Steiner Israel
Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur Neurol. 2018;80(5-6):341-344. doi: 10.1159/000496805. Epub 2019 Mar 29.
The use of neuroimaging as part of the initial workup in the emergency department (ED) for patients with atraumatic headache is increasing, whereas the proportion of cases in which clinically significant intracranial pathology is detected is decreasing. In the last few decades, the exposure to medical ionized radiation from utilization of computer tomography (CT) increased dramatically, raising concern about radiation-induced cancer. Different guidelines were suggested to address the role of neuroimaging in the investigation of adult patients presenting to the ED with nontraumatic headache.
We retrospectively evaluated data from all consecutive patients who underwent a head CT in the ED for the evaluation of headache during 2015. Patients were included only if a normal neurologic examination was documented.
In total, 422 patients were included. About 43.4% of scans were normal. Most abnormal findings were sinusitis (148 patients, 35%) or ischemic changes. Seven CT scans (1.6%) showed clinically significant findings requiring an immediate change in management.
A normal neurologic examination, even when performed by a neurologist, does not rule out a significant secondary cause for headache. A CT scan in the ED is indicated for patients presenting with severe nonremitting headache who never had neuroimaging in the past.
在急诊科（ED），将神经影像学检查作为非创伤性头痛患者初始检查的一部分的情况日益增多，而检测出具有临床意义的颅内病变的病例比例却在下降。在过去几十年中，因使用计算机断层扫描（CT）而受到的医用电离辐射大幅增加，这引发了对辐射诱发癌症的担忧。人们提出了不同的指南，以阐明神经影像学在急诊科对非创伤性头痛成年患者进行检查时所起的作用。
我们回顾性评估了2015年在急诊科因头痛接受头部CT检查的所有连续患者的数据。仅纳入有正常神经系统检查记录的患者。
共纳入422例患者。约43.4%的扫描结果正常。大多数异常发现为鼻窦炎（148例患者，35%）或缺血性改变。7例CT扫描（1.6%）显示出需要立即改变治疗方案的具有临床意义的发现。
即使由神经科医生进行的正常神经系统检查，也不能排除头痛存在重要的继发原因。对于过去从未进行过神经影像学检查且患有严重持续性头痛的患者，在急诊科应进行CT扫描。
