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Repeat CT or MRI in posttraumatic headache
S H Landy1, T B Donovan, R E Laster
1Wesley Headache Clinic, Methodist Hospitals of Memphis, TN 38104, USA.
Headache
|January 1, 1996
Summary
Repeat brain imaging like CT or MRI is recommended for persistent posttraumatic headache, especially with mental status changes. Initial scans may miss serious injuries such as subdural hematomas or temporal lobe hemorrhage.
Area of Science:
- Neurology
- Radiology
- Trauma Care
Background:
- Posttraumatic headache (PTH) is a common sequela of head injury.
- Initial neuroimaging (CT scan) is often performed to rule out acute intracranial pathology.
- The diagnostic utility of a single initial CT scan in persistent PTH is debated.
Observation:
- Two cases of patients presenting with posttraumatic headache are described.
- Both patients initially had negative computed tomography (CT) scans of the brain.
- Symptoms persisted, prompting further investigation.
Findings:
- One patient was diagnosed with bilateral subdural hematomas on a repeat CT scan.
- The second patient was found to have a temporal lobe hemorrhage via magnetic resonance imaging (MRI).
- These findings highlight the potential for missed diagnoses on initial imaging.
Implications:
- Repeat neuroimaging (CT or MRI) should be considered for patients with persistent posttraumatic headache.
- Clinicians should maintain a low threshold for re-imaging when mental status changes are present alongside PTH.
- This approach may improve the detection of delayed or initially missed intracranial injuries, optimizing patient management.