Imaging Headache Final 111008
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Transcript of Imaging Headache Final 111008
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Prof.M.Tameem AkhtarD i r e c t o r , D e p t t o f R a d i o l o g y
D r . Z i a u d d i n U n i v e r s i t yK a r a c h i
ImagingImaging
HeadacheHeadache
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80% people have HAs ?? types 40% severe & disabling
Only 5% present to a doctor for help
Of pts presenting in ED, 10% have 2 causes: -- of these:Aneurysm: 2 - 5%
Brain tumour: 1%
A/V malformation: 0.8%
HeadacheHeadache
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4CAUSESCAUSES
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Primary causes:
Tension headache ------ 90%
Migraine ----- 2nd most common
Cluster Headaches very severe but more
unusual
Radiolo , little role to la , ?? exclusionalRadiolo , little role to pla , ?? exclusional
Common Causes of headacheCommon Causes of headache
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Secondary2. Sinusitis3. Dental, TMJ abnormalities4. Neck anomalies5. Post concussion6. Trigeminal neuralgia7. Hypertension
8. Viral infections colds, influenza9. Alcohol withdrawal hangover10. Dehydration
Radiolo , direct, s ecific, exclusional, roleRadiolo , direct, specific, exclusional, role
Common Causes of headacheCommon Causes of headache
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Cerebral abscess Cerebral tumour Intracranial haematoma
Subdural/ Epidural/ Extradural
Meningitis
Aneurysm Arteritis
Radiolo , essential... CT or MRIRadiolo , essential... CT or MRI
Other causes of headacheOther causes of headache
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DONT FORGET BABIES:
1. Ischemia2. Haemorrhage
3. Mass
4. Developmental
Radiology, US in 1Radiology, US in 1stst instance ... CT scan or MRI later oninstance ... CT scan or MRI later on
Causes of headache in kidsCauses of headache in kids
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RADIOLOGICALRADIOLOGICALInvestigation techniquesInvestigation techniques
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Plain X-ray >>> role??
Angio therapeutic; embolization
CROSS SECTIONAL
CT / MDCT/ CTA/ 3D
MRI/MRA/MRV
US (infant)
Investigation techniquesInvestigation techniques
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ULTRASOUNULTRASOUN
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Pre-natal & neonatal neurology screening
Definitive in infants:
1. ICH
2. HIE
3. Infection
4. Developmental malformations of brain5. SOL
US choiceUS choice
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AdvantagesAdvantages DisadvantagesDisadvantages
1. Non-invasive.2. Inexpensive.
3. Portable.
4. Fast.
5. Multiplanar.
6. No contrast agents.
7. No sedation ??.
1. Cranial exams limitedto infants.
2. Operator dependent.
3. View limited by probe
size.4. Needs a window.
5. Artefacts can mimic apathology.
ULTRASOUNDULTRASOUND
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US superior to CT.
CT for extracerebral hge SAH / SDH.CT for posterior fossa collections.
MRI superior to all CT applications.
some problems in early neonatal period.
Neonates: US vs otherNeonates: US vs otherNeuro-imagingNeuro-imaging
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CTCT
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1. Acute trauma.
2. Acute hge.
3. Infection.
4. Infarction/Stroke.
5. Malformations.
6. Atrophy.
7. Hydrocephalus.8. Skull lesions.
9. Calcified lesions.
10. Orbits, sinuses, petrous bones.
CT is of choiceCT is of choice
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CT
AdvantagesAdvantages DisadvantagesDisadvantages
1. Fast
2. Easily accessible mosthospitals in emergencies
3. Fine bone resolution
4. Modern scanners
multiplanar imaging?? Orbits
Sinuses
TMJs
Sellar masses
1. Radiation dose !
2. Sedation in restless pts &
young children
3. I.V. contrast risks
4. Not portable
5. Metallic artefacts due to
beam hardening
surgical clips
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MRIMRI
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1. Brain maturation2. Encephalitis3. Vasculitis4. Small lesions:
1. abscesses,2. trauma (NAI)
5. Tumours:1. Aqueduct.2. Brainstem.3. Pituitary.
6. Neurodegenerativediseases.
7. Neuromigratorydisorders.
8. Infarction, early detection
9. AVMs.10. Myelination.
MRI indicationsMRI indications
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1. Versatile2. Non-ionising radiation
3. Non-invasive
4. Multi-planar
5. High resolution
MRIMRI
1. Slower2. Motion sensitive3. Claustrophobia ?
Open magnet4. Sedation for children &
anxious adults
5. Difficult access emergency & ICU
6. Expensive???
AdvantagesAdvantages DisadvantagesDisadvantages
C l i
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Neuro-imaging useful to identify astructural lesion
Tests should be avoided if they will
not lead to a change in management;
ConclusioConclusio
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PNS XPNS X
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PNS X-PNS X-
SinusitisSinusitis
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SinusitisSinusitis
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26CholesteatomaCholesteatoma
AA
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AneurysmAneurysm
CTACTA
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28AneurysmAneurysm
CTACTA
A / b liA / b li
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Aneurysm/embolismAneurysm/embolism
A l i f B iA l i f B i
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Age of pt. Localization
Intra vs extra-axialWhat compartmentMid line crossing
CT & MR characteristics:Calcifications, fat, cysticT1, T2, DWI
Contrast enhancementMass effect edemaSolitary MultiplePseudo-tumour ?
Analysis of BrainAnalysis of Brain
Sk llSkull XX
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SkullSkull X-X-
Acoustic NeuromaAcoustic Neuroma
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MeningioMeningio
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SOSO
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SOSO
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Ring enhancingRing enhancing
SOLSOL
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SOLSOL
SOSO
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SOSO
SOLSOL
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SOLSOL
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OBSTRUCTIVEOBSTRUCTIVE
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OBSTRUCTIVEOBSTRUCTIVE
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SAHSAHSAH
STROKSTROK
SAHSAH
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SAHSAH
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STROKSTROK
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SAH
STROKSTROK
STROKSTROK
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STROKSTROK
SDHSDH
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SDHSDH
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47BONY METSBONY METS
SummarySummary
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Most HAs will be 1, but mustrecognize the Red Flags of serious2 HA.
Use of correct modality..
SummarySummary
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