Computed tomography in emergency department in patients with headache without focal neurological abnormalities

Abstract

Introduction. Headache is a common reason for presentation in emergency department (ED). The aim of this research was to determine the incidence of positive computed tomography (CT) findings in patients with headache without focal neurological abnormalities in ED. Material and methods. The results of the native CT scans in ED were retrospectively analyzed. Exclusion criteria included: focal neurological abnormalities, previous head trauma, underlying malignancy, brain metastasis, previous brain operation, dizziness, fever, nausea, vomiting, coagulopathy. As a clinically significant finding we took into account tumors, hemorrhage and acute ischemic lesion. 108 patients met these criteria. The age range was from 18 to 87 years, with mean of 49.5 years, 63% of the patients were female and 37% were male. Results. Normal CT findings were found in 82 patients (75.9%). 26 patients (24.1%) had pathological findings, out of that number 17 (15.7%) findings were clinically irrelevant and 9 (8.3%) were clinically significant. Out of the 9 clinically significant findings, tumor process was found in 5 (4.6%) patients, hemorrhage was found in 3 (2.8%) patients and ischemic lesion was found in 1 (0.9%) patient. In two patients with hemorrhage a subarachnoid hemorrhage was found, with an incidence of 1.8%. All of the 9 clinically signifi cant fi ndings were further evaluated by MR and/or CT angiography and in 2 cases there was a change in initial CT diagnosis but without any change in the category of outcome. Conclusions. Our research revealed 8.3% of clinically significant emergency examinations in patients with headache without focal neurological abnormalities.

Keywords

• headache
• emergency department
• computed tomography (ct)