Unusual Brain MRI Findings in Patients Imaged for Headache: a Case Series
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UNCOMMON AND/OR UNUSUAL HEADACHES AND SYNDROMES (J AILANI, SECTION EDITOR)
Unusual Brain MRI Findings in Patients Imaged for Headache: a Case Series Yadira Flores-Montanez 1
&
Stephanie J. Nahas 2,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review We describe a series of cases with unusual brain MRI findings in patients who present with headache disorders. Recent Findings Incidental findings in patients imaged for headache include the following: aneurysm, arachnoid cyst, cerebral vascular malformations, Arnold-Chiari malformations, empty sella turcica, gray matter heterotopias, mastoiditis, mega cisterna magna, meningioma, normal variants of cerebral circulation, paranasal sinus disease, pineal cyst, pituitary tumor, Rathke’s cleft cyst, skull hyperostosis, and vestibular schwannoma. The most common abnormal MRI findings encountered in migraine are nonspecific white matter lesions. Summary The current 2019 guidelines from the American College of Radiology and American Headache Society recommend against ordering neuroimaging in patients with a high probability of a primary headache disorder not typically associated with diagnostic imaging findings and who have normal neurologic exam in addition to no red flags in history. Often, unnecessary neuroimaging yields incidental findings, and this typically results in patient anxiety and further unnecessary testing. Detailed below are a series of cases in which unusual findings were found in patients presenting to our clinic for further evaluation of headache disorders. Imaging may have been done prior to presentation to us or by us due to concern for secondary causes. Keywords Headache . Migraine . Brain MRI . Abnormal MRI
Introduction Neuroimaging is frequently ordered in patients presenting to outpatient clinics with primary headache disorders. The This article is part of the Topical Collection on Uncommon and/or Unusual Headaches and Syndromes * Yadira Flores-Montanez [email protected] Stephanie J. Nahas [email protected] 1
Jefferson Headache Center, 900 Walnut Street Suite 200, Philadelphia, PA 19107, USA
2
Director, Headache Medicine Fellowship Program, Jefferson Headache Center, 900 Walnut Street Suite 200, Philadelphia 19107, PA, USA
3
Assistant Director, Neurology Residency Program, Jefferson Headache Center, 900 Walnut Street Suite 200, Philadelphia, PA 19107, USA
guidelines from the American College of Radiology [1•] and American Headache Society [2••] recommend against neuroimaging of primary headache disorders in the absence of red flags or an abnormal neurologic examination. Often, misguided use of this resource yields incidental findings, a situation which commonly results in patient anxiety and further testing which may be unnecessary. According to the American College of Radiology Appropriateness Criteria, in patients with suspected primary headache disorders and no focal findings on exam, any need for neuroimaging should be considered in the context of these criteria
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