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Published in: Emergency Radiology 5/2010

01-09-2010 | Review Article

Imaging evaluation of the patient with worst headache of life—it's not all subarachnoid hemorrhage

Author: James M. Provenzale

Published in: Emergency Radiology | Issue 5/2010

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Abstract

The radiologist working in the emergency radiology setting is often faced with evaluating imaging findings of the patient whose chief complaint is that of the worst headache of life. The diagnosis of subarachnoid hemorrhage (SAH) is usually the initial consideration before imaging is performed and, appropriately, must be quickly diagnosed. However, a number of entities can simulate SAH on imaging studies. Those entities are presented here. In addition, a number of disease processes other than SAH can produce worst headache of life. Some of the most important entities, and their CT and MR findings, are reviewed here.
Literature
1.
go back to reference Provenzale JM, Hacein-Bey L (2009) CT evaluation of subarachnoid hemorrhage: a practical review for the radiologist interpreting emergency room studies. Emerg Radiol 16:441–451CrossRefPubMed Provenzale JM, Hacein-Bey L (2009) CT evaluation of subarachnoid hemorrhage: a practical review for the radiologist interpreting emergency room studies. Emerg Radiol 16:441–451CrossRefPubMed
3.
go back to reference Perry JJ, Stiell IG, Wells GA et al (2005) Attitudes and judgment of emergency physicians in the management of patients with acute headache. Acad Emerg Med 12:33–37CrossRefPubMed Perry JJ, Stiell IG, Wells GA et al (2005) Attitudes and judgment of emergency physicians in the management of patients with acute headache. Acad Emerg Med 12:33–37CrossRefPubMed
4.
go back to reference Ang SH, Chan YC, Mahadevan M (2009) Emergency department headache admissions in an acute care hospital: why do they occur and what can we do about it? Ann Acad Med Singapore 38:1007–1010PubMed Ang SH, Chan YC, Mahadevan M (2009) Emergency department headache admissions in an acute care hospital: why do they occur and what can we do about it? Ann Acad Med Singapore 38:1007–1010PubMed
5.
go back to reference Dupont SA, Wijdicks EF, Manno EM, Rabinstein AA (2008) Thunderclap headache and normal computed tomographic results: value of cerebrospinal fluid analysis. Mayo Clin Proc 83:1326–1331CrossRefPubMed Dupont SA, Wijdicks EF, Manno EM, Rabinstein AA (2008) Thunderclap headache and normal computed tomographic results: value of cerebrospinal fluid analysis. Mayo Clin Proc 83:1326–1331CrossRefPubMed
6.
go back to reference Zhu XL, Chan MS, Poon WS (1997) Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke 28:1406–1409PubMed Zhu XL, Chan MS, Poon WS (1997) Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke 28:1406–1409PubMed
7.
go back to reference Griffiths PD, Coley SC, Romanowski CA et al (2003) Contrast-enhanced fluid-attenuated inversion recovery imaging for leptomeningeal disease in children. AJNR Am J Neuroradiol 24:719–723PubMed Griffiths PD, Coley SC, Romanowski CA et al (2003) Contrast-enhanced fluid-attenuated inversion recovery imaging for leptomeningeal disease in children. AJNR Am J Neuroradiol 24:719–723PubMed
8.
go back to reference Galassi W, Phuttharak W, Hesselink JR, Healy JF, Dietrich RB, Imbesi SG (2005) Intracranial meningeal disease: comparison of contrast-enhanced MR imaging with fluid-attenuated inversion recovery and fat-suppressed T1-weighted sequences. AJNR Am J Neuroradiol 26:553–559PubMed Galassi W, Phuttharak W, Hesselink JR, Healy JF, Dietrich RB, Imbesi SG (2005) Intracranial meningeal disease: comparison of contrast-enhanced MR imaging with fluid-attenuated inversion recovery and fat-suppressed T1-weighted sequences. AJNR Am J Neuroradiol 26:553–559PubMed
9.
go back to reference Silbert PL, Mokri B, Schievink WI (1995) Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology 45:1517–1522PubMed Silbert PL, Mokri B, Schievink WI (1995) Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology 45:1517–1522PubMed
10.
go back to reference Provenzale JM (1995) Dissection of the internal carotid and vertebral arteries: imaging findings. AJR Am J Roentgenol 165:1099–1104PubMed Provenzale JM (1995) Dissection of the internal carotid and vertebral arteries: imaging findings. AJR Am J Roentgenol 165:1099–1104PubMed
11.
go back to reference Stringaris K, Liberopoulos K, Giaka E et al (1996) Three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography in carotid artery dissections. Int Angiol 15:20–25PubMed Stringaris K, Liberopoulos K, Giaka E et al (1996) Three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography in carotid artery dissections. Int Angiol 15:20–25PubMed
12.
go back to reference Vertinsky AT, Schwartz NE, Fischbein NJ, Rosenberg J, Albers GW, Zaharchuk G (2008) Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol 29:1753–1760CrossRefPubMed Vertinsky AT, Schwartz NE, Fischbein NJ, Rosenberg J, Albers GW, Zaharchuk G (2008) Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol 29:1753–1760CrossRefPubMed
13.
go back to reference Harris W (1944) Paroxsymal and postural headaches from intraventricular cysts and tumors. Lancet 2:654–655CrossRef Harris W (1944) Paroxsymal and postural headaches from intraventricular cysts and tumors. Lancet 2:654–655CrossRef
14.
go back to reference Desai KI, Nadkarni TD, Muzumdar DP, Goel AH (2002) Surgical management of colloid cyst of the third ventricle—a study of 105 cases. Surg Neurol 57:295–302CrossRefPubMed Desai KI, Nadkarni TD, Muzumdar DP, Goel AH (2002) Surgical management of colloid cyst of the third ventricle—a study of 105 cases. Surg Neurol 57:295–302CrossRefPubMed
15.
go back to reference de Witt Hamer PC, Verstegen MJ, De Haan RJ et al (2002) High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle. J Neurosurg 97:1249 de Witt Hamer PC, Verstegen MJ, De Haan RJ et al (2002) High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle. J Neurosurg 97:1249
16.
go back to reference Pollock BE, Huston J 3rd (1999) Natural history of asymptomatic colloid cysts of the third ventricle. J Neurosurg 91:364–369CrossRefPubMed Pollock BE, Huston J 3rd (1999) Natural history of asymptomatic colloid cysts of the third ventricle. J Neurosurg 91:364–369CrossRefPubMed
17.
go back to reference Alnaghmoosh N, Alkhani A (2006) Colloid cysts in children, a clinical and radiological study. Childs Nerv Syst 22:514–516CrossRefPubMed Alnaghmoosh N, Alkhani A (2006) Colloid cysts in children, a clinical and radiological study. Childs Nerv Syst 22:514–516CrossRefPubMed
18.
go back to reference Weisberg LA (1984) Clinical-computed tomographic correlations in colloid cysts of the third ventricle. Comput Radiol 8:157–163CrossRefPubMed Weisberg LA (1984) Clinical-computed tomographic correlations in colloid cysts of the third ventricle. Comput Radiol 8:157–163CrossRefPubMed
19.
go back to reference Powell MP, Torrens MJ, Thomson JL, Horgan JG (1983) Isodense colloid cysts of the third ventricle: a diagnostic and therapeutic problem resolved by ventriculoscopy. Neurosurgery 13:234–237CrossRefPubMed Powell MP, Torrens MJ, Thomson JL, Horgan JG (1983) Isodense colloid cysts of the third ventricle: a diagnostic and therapeutic problem resolved by ventriculoscopy. Neurosurgery 13:234–237CrossRefPubMed
20.
go back to reference Ferro JM, Canhão P, Stam J (2009) for the ISCVT Investigators. Delay in the diagnosis of cerebral vein and dural sinus thrombosis: influence on outcome. Stroke 40:3133–3138CrossRefPubMed Ferro JM, Canhão P, Stam J (2009) for the ISCVT Investigators. Delay in the diagnosis of cerebral vein and dural sinus thrombosis: influence on outcome. Stroke 40:3133–3138CrossRefPubMed
21.
go back to reference Linn J, Michl S, Katja B, et al (2010) Cortical vein thrombosis: the diagnostic value of different imaging modalities. Neuroradiology. PMID: 20107776 (in press) Linn J, Michl S, Katja B, et al (2010) Cortical vein thrombosis: the diagnostic value of different imaging modalities. Neuroradiology. PMID: 20107776 (in press)
22.
go back to reference Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S (1987) The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis. Radiology 162:779–785PubMed Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S (1987) The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis. Radiology 162:779–785PubMed
23.
go back to reference Agid R, Farb RI, Willinsky RA, Mikulis DJ, Tomlinson G (2006) Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology 48:521–527CrossRefPubMed Agid R, Farb RI, Willinsky RA, Mikulis DJ, Tomlinson G (2006) Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology 48:521–527CrossRefPubMed
24.
25.
go back to reference Vazquez-Barquero A, Ibanez FJ, Herrera S et al (1994) Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalalgia 14:270–272CrossRefPubMed Vazquez-Barquero A, Ibanez FJ, Herrera S et al (1994) Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalalgia 14:270–272CrossRefPubMed
26.
go back to reference Childhood Brain Tumor Consortium (1991) The epidemiology of headache among children with brain tumor. headache in children with brain tumors. J Neuro-oncol 10:31–46CrossRef Childhood Brain Tumor Consortium (1991) The epidemiology of headache among children with brain tumor. headache in children with brain tumors. J Neuro-oncol 10:31–46CrossRef
27.
go back to reference Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA (1999) Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf) 51:181–188CrossRef Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA (1999) Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf) 51:181–188CrossRef
28.
go back to reference Schievink WI (2006) Spontaneous spinal cerebrospinal fluid Leaks and intracranial hypotension. JAMA 295:2286–2296CrossRefPubMed Schievink WI (2006) Spontaneous spinal cerebrospinal fluid Leaks and intracranial hypotension. JAMA 295:2286–2296CrossRefPubMed
29.
go back to reference O'Carroll CP, Brant-Zawadzki M (1999) The syndrome of spontaneous intracranial hypotension. Cephalalgia 19:80–87CrossRefPubMed O'Carroll CP, Brant-Zawadzki M (1999) The syndrome of spontaneous intracranial hypotension. Cephalalgia 19:80–87CrossRefPubMed
30.
go back to reference Provenzale JM (2000) CT and MR imaging of nontraumatic neurologic emergencies. AJR Am J Roentgenol 174:289–299PubMed Provenzale JM (2000) CT and MR imaging of nontraumatic neurologic emergencies. AJR Am J Roentgenol 174:289–299PubMed
Metadata
Title
Imaging evaluation of the patient with worst headache of life—it's not all subarachnoid hemorrhage
Author
James M. Provenzale
Publication date
01-09-2010
Publisher
Springer-Verlag
Published in
Emergency Radiology / Issue 5/2010
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI
https://doi.org/10.1007/s10140-010-0882-y

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