Pitfalls in Neuroimaging of Headache: A Case Report and Review of the Literature. (28th February 2013)

• Record Type: Journal Article
• Authors: Vallamkondu, V.; Shakeel, M.; Hussain, A.; McAteer, D.
• Other Names: Chhetri D. K. Academic Editor.; DiNardo L. J. Academic Editor.
• Is Part Of: Case reports in otolaryngology. Volume 2013(2013)
• Publication Date: 2013-02-28
• Subjects: Otolaryngology -- Periodicals; Otolaryngology -- Case studies -- Periodicals; Otolaryngology; Otorhinolaryngologic Diseases; Otolaryngology; Periodicals; Case studies; Periodicals; Case Reports; Fulltext; Internet Resources; Periodicals; 617.51
• DOI: 10.1155/2013/735147
• Languages: English
• ISSNs: 2090-6765

Abstract

Abstract : 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.