Disruption to contrast agent supply chains for radiology investigations has become an additional consequence of the COVID-19 pandemic. Various recommendations, including dose reductions and choices of alternative agents, have been made to help account for this limited availability. This case demonstrated how two separate computed tomography (CT) venograms with different contrast agents and similar timing, undertaken on the same day for the same patient, yielded different results; cerebral venous thromboses were more prominent in the subsequent scan. Although there were features suggestive of thrombosis on the first scan, repeat imaging was required to further characterize the lesions identified. The case exemplifies the notion that diagnostic imaging should always be guided by a detailed history and examination. It also raises the discussion point of whether more strict or uniform protocols should be developed to facilitate contrast administration for radiology investigations. It is important that appropriate doses are always administered to maximize diagnostic yield.
The case highlights the importance of a detailed medical history and examination and comprehensive investigations. It further demonstrated that even correctly focused investi-
Introduction: This paper reinforces the concept that headaches reside on a continuum with migraine type headache at one end of the spectrum and Tension Type Headache (TTHs) at the other with what used to be referred to as tension/vascular headaches, along that continuum.
Background information:This brief overview of headaches is based upon almost half a century of clinical neurological experience by the author, rather than an in depth analysis of definitions and is also dependent upon impressions of patient responses to treatment.Results: Based upon clinical experience, one of the most common complaints that present to the neurologist is that of chronic headache, or headache in general, and so long as the headache is significantly intrusive it is referred to the consultant as a case of migraine even if the evidence favours an alternative headache type such as TTH.Discussion: This paper confirms the concept, demonstrated in previous studies, that there is a continuum spectrum of headache types, with patients moving along that continuum with changing presentations at various times during a long history of headaches.
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