这位头痛患者有偏头痛还是需要神经成像?
Michael E Detsky1, Devon R McDonald, Mark O Baerlocher
1Faculty of Medicine, Medicine, University of Toronto, Toronto, Ontario.
JAMA
|September 14, 2006
概括
诊断偏头痛和确定神经成像的需要可以通过特定的患者病史元素来帮助. 四个关键特征准确地识别了偏头痛,而其他特征则表明了需要进一步调查的潜在内异常.
科学领域:
- 神经学 神经学
- 临床诊断 临床诊断 临床诊断
背景情况:
- 头痛评估涉及将偏头痛与其他类型区分开来,并确定需要神经成像的患者.
- 病史和体检对于诊断和指导进一步调查至关重要.
研究的目的:
- 评估患者病史和体检在分辨偏头痛方面的有用性.
- 确定预测头痛患者神经成像需要的临床特征.
主要方法:
- 对MEDLINE索引研究 (1966-2005) 的系统审查.
- 评估了偏头痛诊断查问题的表现 (国际头痛协会标准).
- 评估了用于预测内病理的临床检查准确性 (CT/MRI参考).
主要成果:
- 四项研究 (1745名患者) 显示了对偏头痛的高灵敏度/特异性,具有3-4个POUNDing标准 (脉冲,持续时间4-72小时,单边,恶心,致残).
- 对11项神经成像研究的综合分析 (3725名患者) 确定了内异常的预测因素:集群头痛,神经检查异常,未定义的头痛,带有光环的头痛,运动加重的头痛和带有吐的头痛.
- 没有特征可靠地排除了显著的病理.
结论:
- 四个历史特征可以准确诊断偏头痛.
- 特定的临床发现需要神经成像来排除严重的内异常.
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