Oğuzhan ÖZDEMİR, Muhammet Bora UZUNER, Döndü ÜLKER ÜSTEBAY

Predictive roles of interpeduncular and pontomesencephalic angle measurements, which are anatomical landmarks in cranial MRI, in the differential diagnosis of pediatric headache

Aim: This study aims to comparatively assess the interpeduncular and pontomesencephalic angles in the cranial magnetic resonance imaging (MRI) images of pediatric headache patients. Thus, we think that it will contribute to the studies to be conducted for the objective evaluation of pediatric headache requiring the use of cerebral MRI. Materials and Methods: This retrospective study was performed using clinical and radiological data extracted from the medical files of 157 patients and 49 controls. Our population consisted of 101 females (49 %) and 105 males (51 %). The patient population was divided into 4 categories as follows: non-specific headache (thought to be of the tension-type), vasovagal syncope, sinusitis, and epilepsy. Interpeduncular (IP) and pontomesencephalic (PM) angles of patients and control groups were compared on MR images. Results: The population average age in this series was 11.05 ± 3.78 (range, 5 to 17) years. The comparison of IP angleyielded statistically significant differences between tensiontypeheadache-epilepsy, tension type-headache- vasovagal syncope, epilepsy-control, and vasovagal syncope-control groups. Multiple comparisons for PM angle demonstrated remarkable differences between headache-control, epilepsy-control, epilepsy-sinusitis, and control- vasovagal syncope groups. Conclusion: Our results indicated that measurements of IP and PM angles on the cerebral MRI views of children whose etiology could not be clarified and for whom cranial imaging was required, may yield valuable data in the differential diagnosis. We are of the opinion that by working on larger data sets in the future, more valuable data can be obtained in differential diagnosis.

PDF

___

1. Maytal J, Bienkowski RS, Patel M, Eviatar L.The value of brain imaging in children with headaches. Pediatrics 1995;96:413-416
2. Yılmaz Ü, Çeleğen M, Yılmaz TS, Gürçınar M, Ünalp A. Childhood headaches and brain magnetic resonance imaging findings. Eur J PaediatrNeurol2014;18:163-170
3. Wang DJ, Pandey SK, Lee DH, Sharma M () Theinterpeduncular angle: a practical and objective marker for the detection and diagnosis of intracranial hypotension on brain MRI. AJNR Am J Neuroradiol.2019;40:1299-1303
4. Aslan K, Gunbey HP, Tomak L, Ozmen Z, Incesu L Magnetic Resonance Imaging of Intracranial Hypotension: Diagnostic Value of Combined Qualitative Signs and Quantitative Metrics. J Comput Assist Tomogr2018;42:92-99
5. Martens D, Oster I, Gottschlling S, Papanagiotou P, Ziegler K, Eymann R, et al.Cerebral MRI and EEG studies in the initial management of pediatric headaches. Swiss Med Wkly2012;142:w13625
6. Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, etal.Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002;59:490-498
7. Tian W, Zhang J, Chen J, Liu Y, Chen X, Wang N.A quantitative study of intracranial hypotensive syndrome by magnetic resonance. ClinNeurolNeurosurg2016;141:71-76
8. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia2018;38:1-211
9. Honningsvåg LM, Håberg AK, Hagen K, Kvistad KA, Stovner LJ, LindeM.White matter hyperintensities and headache: A population-based imaging study (HUNT MRI). Cephalalgia2018;38:1927-1939
10. Schwedt TJ, Guo Y, RothnerAD.“Benign” imaging abnormalities in children and adolescents with headache. Headache 2006;46:387–398
11. Nishioka SA, Gyorkos TW, Joseph L, Collet JP.Selection of subjects for hospital-based epidemiologic studies based on outward manifestations of disease. Clin Invest Med 2001;24: 299–303