The Utility of Neuroimaging in the Evaluation of Children With Migraine or Chronic Daily Headache Who Have Normal Neurological Examinations

Lewis, Donald W.; Dorbad, D.

doi:10.1046/j.1526-4610.2000.040008629.x

Cited by 116 publications

(89 citation statements)

References 11 publications

(11 reference statements)

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“…Similar findings have been reported in the pediatric literature, as illustrated in a 2008 study of 1,275 children presenting with migraine and a normal neurologic examination in which no significant abnormalities were seen on imaging. [9][10][11][12][13][14] Despite the literature showing a vanishingly low pretest probability in the population of interest, our findings indicate that physicians order CT scans in over one-third of pediatric patients presenting with recurrent headaches and a normal neurologic examination. Two recent US studies reached similar conclusions.…”

Section: Frequency Of Ct Scanscontrasting

confidence: 65%

Investigating the necessity of computed tomographic scans in children with headaches: a retrospective review

Gandhi

Lewis

Evans

et al. 2015

CJEM

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Objective: Headaches are a common problem in the pediatric population. In 2002, the American Academy of Neurology (AAN) developed guidelines on neuroimaging for patients presenting with headache. Our objective was to determine the frequency of computed tomographic (CT) scanning ordered by a range of medical practitioners for pediatric patients presenting with primary headache. Methods: A retrospective chart review was conducted at the Children's Hospital of Eastern Ontario (CHEO), a tertiary care centre in Ontario. One hundred fifty-one records of patients referred to the outpatient neurology clinic at CHEO with ''headache'' or ''migraine'' as the primary complaint from 2004 to 2009 were randomly selected. Ninety-nine patients with normal neurologic examinations were ultimately included. Results: Thirty-four patients (34%; 95% CI 25-45) had undergone CT scanning. None of the 34 CT scans (0%; 95% CI 0-10) showed significant findings, and none changed the headache diagnosis or management. Eleven (32%) of the CT scans were ordered by CHEO neurologists, 15 (44%) by community physicians, and 8 (24%) by CHEO emergency physicians. Conclusion: A high proportion of children presenting with primary headaches and a normal neurologic examination undergo CT scanning, despite well-established AAN guidelines regarding neuroimaging. Most of these CT scans do not appear to alter diagnosis and management. A variety of non-evidencebased factors may be encouraging physicians to overinvestigate this population and, as a result, increasing the risk of adverse events due to radiation exposure. Implementing initiatives at a site-based level that promote the use of established guidelines before performing CT scanning in this population may be beneficial. RÉ SUMÉObjectif: Les cé phalé es sont un problè me fré quent chez les enfants. En 2002, l'American Academy of Neurology (AAN) a é laboré des lignes de conduite sur la neuro-imagerie chez les patients souffrant de cé phalé es. L'é tude visait à dé terminer la fré quence des demandes de tomodensitomé trie (TDM) faites par diffé rents types de mé decins praticiens en pé diatrie chez les enfants souffrant de cé phalé es primitives. Mé thode: Nous avons procé dé à un examen ré trospectif de dossiers au Centre hospitalier pour enfants de l'est de l'Ontario (CHEO), un centre de soins tertiaires, en Ontario. Cent cinquante et un dossiers de patients dirigé s au service de consultation externe en neurologie, au CHEO, de 2004 à 2009, pour des «cé phalé es» ou des «migraines» qui constituaient le principal motif de consultation, ont é té choisis au hasard. À cela se sont ajouté s 99 patients ayant un examen neurologique normal. Ré sultats: Trente-quatre patients (34%; IC à 95%: 25-45) ont subi une TDM. Dans aucun cas (0%; IC à 95%: 0-10), l'examen n'a ré vé lé d'anomalies importantes ni changé le diagnostic de cé phalé e ou la prise en charge. Onze (32%) examens par TDM ont é té demandé s par des neurologues, au CHEO; 15 (44%), par des mé decins de ville; et 8 (24%) par des urgentologues, ...

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Section: Frequency Of Ct Scanscontrasting

confidence: 65%

Investigating the necessity of computed tomographic scans in children with headaches: a retrospective review

Gandhi

Lewis

Evans

et al. 2015

CJEM

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“…UU., la tasa de estudios de neuroimagenología en los niños con cefalea varía entre el 35,4% y el 57,6%. [10][11][12] En el estudio actual, se realizaron estudios de neuroimagenología del cerebro en el 85% de los pacientes. La tasa de neuroimagenología fue mayor en nuestro estudio que en los estudios previos publicados realizados en nuestro país.…”

Section: Figura 2 Rmn De Cerebro De Los Pacientes; Las Flechas De Counclassified

“…Anteriormente, se informó que la frecuencia de la enfermedad de los senos paranasales era del 1,3% al 13,7% en los pacientes sometidos a estudios de diagnóstico por imágenes para la cefalea. 10,12,15 Esto coincide con nuestros resultados.…”

Section: Figura 2 Rmn De Cerebro De Los Pacientes; Las Flechas De Counclassified

“…De manera similar, en los estudios previos en niños con cefalea, se observó malformación de Chiari tipo 1 en el 2,7% al 5,8% de los participantes. 10,12,22 La prevalencia de la malformación de Chiari tipo 1 (1,7%) y de ectopia amigdalina cerebelosa (0,8%) fue también del 2,5% en los pacientes pediátricos atendidos en los consultorios externos de neurología. 20 Los quistes aracnoideos son bolsas llenas de líquido cefalorraquídeo dentro de la membrana aracnoidea.…”

Section: Figura 2 Rmn De Cerebro De Los Pacientes; Las Flechas De Counclassified

“…La prevalencia de los quistes aracnoideos en los estudios previos sobre la cefalea varía entre el 1% y el 4,4%. 10,12,13,24 En este estudio, los estudios de diagnóstico por imágenes de los pacientes con quistes aracnoideos mostraron solo una masa leve y los síntomas de la cefalea no se consideraron relacionados con el quiste.…”

Section: Figura 2 Rmn De Cerebro De Los Pacientes; Las Flechas De Counclassified

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Resultados de la resonancia magnética nuclear de cerebro en niños con cefalea

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Glymphatic Imaging in Pediatrics

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The glymphatic system, which facilitates cerebrospinal fluid (CSF) flow through the brain parenchyma, is important for brain development and waste clearance. Advances in imaging techniques, particularly magnetic resonance imaging, have make it possible to evaluate glymphatic structures and functions in vivo. Recently, several studies have focused on the development and alterations of the glymphatic system in pediatric disorders. This review discusses the development of the glymphatic system, advances of imaging techniques and their applications in pediatric disorders. First, the results of the reviewed studies indicate that the development of the glymphatic system is a long‐lasting process that continues into adulthood. Second, there is a need for improved glymphatic imaging techniques that are non‐invasive and fast to improve suitability for pediatric applications, as some of existing methods use contrast injection and are susceptible to motion artifacts from long scanning times. Several novel techniques are potentially feasible for pediatric patients and may be used in the future. Third, the glymphatic dysfunction is associated with a large number of pediatric disorders, although only a few have recently been investigated. In conclusion, research on the pediatric glymphatic system remains an emerging field. The preliminary applications of glymphatic imaging techniques have provided unique insight into the pathological mechanism of pediatric diseases, but mainly limited in visualization of enlarged perivascular spaces and morphological measurements on CSF volumes. More in‐depth studies on glymphatic functions are required to improve our understanding of the mechanisms underlying brain development and pediatric diseases.Level of Evidence5Technical EfficacyStage 3

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The Utility of Neuroimaging in the Evaluation of Children With Migraine or Chronic Daily Headache Who Have Normal Neurological Examinations

Cited by 116 publications

References 11 publications

Investigating the necessity of computed tomographic scans in children with headaches: a retrospective review

Investigating the necessity of computed tomographic scans in children with headaches: a retrospective review

Resultados de la resonancia magnética nuclear de cerebro en niños con cefalea

Glymphatic Imaging in Pediatrics

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