Ayse Secil EKSİOGLU, Berna UCAN, Nesrin CEYLAN

Çocukluk Çağı Baş Ağrılarında Kranial Manyetik Rezonans Görüntülemenin Tanısal Değeri

Amaç: Baş ağrısı çocukluk çağında sık karşılaşılan bir yakınmadır. Değerlendirmede görüntüleme yöntemlerine sıklıkla başvurulmaktadır. Bu çalışmada, baş ağrısı ile başvuran çocuklarda görüntüleme yöntemleri ile saptanan bulguların sıklığını saptamak ve baş ağrısında SWI (Susceptibility Weighted Imaging) ve DWI (Difusion Weighted Imaging) sekansların olası gerekliliğine vurgu yaparak Manyetik Rezonans Görüntüleme (MRG)’nin tanıdaki yerininin tartışılması amaçlandı. Gereç ve Yöntemler: Çalışmaya baş ağrısı yakınması ile başvuran ve MRG yapılan 119 hasta (51 E / 68 K; ortalama 11.63 ± 3.69 yıl) dahil edildi. Baş ağrısının başlangıç yaşı, süresi, tipi, atak sıklığı ile hastanın fizik ve nörolojik muayene bulguları kaydedildi. Kranial MRG’de izlenen patolojiler değerlendirildi. Bulgular: Hastaların 89’unda (%74.8) primer, 19’unda (%16) sekonder, 11’inde ise (%9.2) spesifiye edilemeyen baş ağrısı mevcuttu. MRG yapılan hastaların, %63.9’unda pozitif görüntüleme bulguları olmakla birlikte bunların çok azı başağrısı semptomunu açıklayıcı intrakraniyel bir patolojiydi (5/76; %6.5). En sık rastlanan pozitif bulgu sinüzitti (46/76; %61). SWI görüntülerde 2 hastada gelişimsel venöz anomali, 1 hastada kavernom tespit edildi. DWI görüntülerde ise hiçbir hastada patolojik bulgu saptanmadı. Baş ağrısının tipinin, atak süresinin, cinsiyetin, yaşın MRG’de patoloji tespit edilme oranını anlamlı şekilde değiştirmediği görüldü. Buna karşın atak süresi, ek patoloji varlığı anlamlı bulundu. Klinisyenin gerekli görmesi sonucu veya muayene bulgusu olduğu için tetkik edilenlerde MRG’de patoloji tespit edilme oranı, aile anksiyetesi sebebiyle tetkik edilenlerden anlamlı şekilde yüksek bulundu. Sonuç: Çocukluk çağında başağrısı varlığında MRG anormal nörolojik muayene bulguları olan hastalara önerilmeli diğer hastalarda görüntüleme öncesi ayrıntılı klinik değerlendirme gerekirse Kulak Burun Boğaz’ı de içeren konsültasyonlarla birlikte yapılmalıdır. MRG’ye SWI ve DWI sekansların eklenmesinde potansiyel yarar vardır. Son olarak ailelerin endişesi MRG istemi yapmak için bir endikasyon olmamalıdır.

Anahtar Kelimeler:

Çocuk, MRG, Baş ağrısı, Manyetik Rezonans Görüntüleme

Value of Cranial Magnetic Resonance Imaging in Childhood Headaches

Objective: Headache is a common complaint in childhood. Imaging methods are frequently used in evaluation. This study aimed to determine the frequency of findings detected by imaging methods in children presenting withheadache and to discuss the importance of Magnetic Resonance Imaging (MRI) in diagnosis by emphasizing the possible necessity of SWI (Susceptibility Weighted Imaging) and DWI (Difusion Weighted Imaging) sequences in headache. Material and Methods: 119 patients (51 M/68 F; mean 11.63±3.69 years) who presented with headache and underwent MRI were included in the study. The age of onset, duration, type, frequency of attacks, physical and neurological examination findings of the patient were recorded. Pathologies observed in cranial MRI were evaluated. Results: Headache was primary in 89 (74.8%) patients, secondary in 19 (16%), and unspecified headache in 11 (9.2%) patients. Although 63.9% of patients who underwent MRI had positive imaging findings, very few of them were intracranial pathology explaining the headache symptom (5/76; 6.5%). The most common positive finding was sinusitis (46/76; 61%). Developmental venous anomaly was detected in 2 patients and cavernoma was detected in 1 patient on SWI images. No pathological finding was detected in any of the patients on DWI images. It was observed that the type of headache, duration of attack, gender and age did not significantly change the rate of pathology detected in MRI. On the other hand, the duration of the attack and the presence of additional pathology were found to be significant. The rate of of pathology in MRI was found to be significantly higher in patients who were examined due to clinical findings or due to examination findings, compared to those who were examined due to family anxiety. Conclusion: In the presence of headache in childhood, MRI should be recommended to patients with abnormal neurological examination findings, and in other patients, a detailed clinical evaluation before imaging should be performed together with consultations including otorhinolaryngology. There is potential benefit in adding SWI and DWI sequences to MRI. Finally, parents concern should not be an indication for an MRI request.

Keywords:

Child, Headache, Magnetic Resonance Imaging, MRI,

PDF

___

Yılmaz Ü, Çeleğen M, Yılmaz TS, Gürçınar M, Ünalp A. Childhood Headaches and Brain Magnetic Resonance Imaging Findings. Eur J Paediatr Neurol 2014;18:163-70.
Dao JM, Qubty W. Headache Diagnosis in Children and Adolescents. Curr Pain Headache Rep 2018;22:17.
Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, et al. 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 27;59:490-8.
Pektezel MY, Konuskan B, Sonmez FM, Oguz KK, Anlar B. Pediatric Headache and Neuroimaging: Experience of Two Tertiary Centers. Childs Nerv Syst 2020;36:173-7.
Sarma A, Poussaint TY.Neuroimaging. Indications and Imaging Modality of Choice in PediatricHeadache. Clin N Am 2019;29:271-89.
Gupta SN, Belay B.J. Intracranial Incidental Findings On Brain MR Images in A Pediatric Neurology Practice: A Retrospective Study. Neurol Sci 2008;264:34-7.
Headache Classification Subcommittee of the International Headache Society The international classification of headache disorders, 2nd ed. Cephalgia 2004;24:1-151.
Olesen J.The International Classification of Headache Disorders, 2nd Edition: Application To Practice. Funct Neurol 2005;20:61-8.
Bayram E, Topcu Y,Karaoglu P, Yis U, Cakmakcı Guleryuz H, Hiz Kurul S. Incidental White Matter Lesions in Children Presenting with Headache. Headache 2013;53:970-6.
Deda G, Caksen H, Öcal A. Headache Etiology in Children: A Retro-Spective Study of 125 Cases. Pediatr Int 2000;42:668-73.
Lewis DW, Dorbad D. The Utility of Neuroimaging in the Evaluation of Children with Migraine Or Chronic Daily Headache Who Have Normal Neurological Examinations. Headache 2000;40:629-32.
Alehan FK. Value of Neuroimaging in the Evaluation of Neurologically Normal Children with Recurrent Headache. J Child Neurol 2002;17:807-9.
Vazquez-Barquero A, Ibanez FJ, Herrera S, Izquierdo JM, Berciano J, Pascual J. Isolated Headache As The Presenting Clinical Manifestation of Intracranial Tumors: A Prospective Study. Cephalalgia 1994;14:270-2.
Morris Z, Whiteley WN, Longstreth WT, Weber F, Lee YC, Tsusuhima Y, et al. Incidental Findings On Brain Magnetic Resonance Imaging: Systematic Review and Meta-Analysis. BMJ 2009;339:b3016.
Karaarslan E, Ulus S, Kürtüncü M. Susceptibility-weighted imaging in migraine with aura. AJNR Am J Neuroradiol 2011;32:E5-7.
Erin M Fedak, Nicholas A Zumberge, Geoffrey L Heyer. The Diagnostic Role For Susceptibility-Weighted MRI During Sporadic Hemiplegic Migraine. Cephalalgia 2013;33:1258-63.