European Journal of Cardiovascular Medicine

Headache may appear as sharp/dullpain or of varying intensity. It may be of acute severe and chronic type. Sometimes it may hamper lifestyle. Sometimes MRI is necessary to diagnose underlying intracranial pathology if any. MRI was done in patients coming to OPD with headache, loss of vision and diplopia to rule out BIH which is also a cause of headache. However, majority are presented with headache only. Every patient referred to MRI brain with headache, age >18yrs of both males and females. In order to diagnose the cause of headache. MRI is preferred modality because of less radiation and multiplanar imaging. All cases who were referred to MRI were initially screened and detailed history and complaints were taken. The brain was solely assessed with MRI not in conjunction with other imaging modalities. MRV was also done whenever necessary.

Aims and objectives:

To study spectrum of findings on MRI in cases of headache and to study various signs of BIH. 

Study design – Hospital based cross sectional observational study.

Study population- Patient referred to department of radiodiagnosis from department of medicine of KGH with headache.

Study location- Andhra medical college, King George Hospital, Vishakapatnam.

Study period- DEC 2022 to OCT 2023.

Inclusion criteria- Patients referred for MRI brain with headache and age >18yrs, both males and females.

Exclusion criteria- Patients with pacemaker, claustrophobia, other identifiable causes of headache and Patients with focal neurological deficit.

MRI PROTOCOL:

The brain was assessed solely on the basis of the MRI appearances and not in conjunction with other imaging modalities. MRI was performed on a Philips Achieva 1.5 T MRI scanner using head coil. In every case examination was performed in supine position. Each examination included an overlapping multislice technique. Scout images were obtained in axial, coronal and sagittal planes. Images are obtained in Axial DWI,T1,T2,FLAIR (SPIR) and T2FFE, Sag T1 and coronal T2 for brain. Brain was screened for all the parameters taken in master chart for presence of any abnormality. If no abnormality is detected then images are screened for presence of signs of BIH.

• Signs in Benign intra cranial hypertension evaluated are: 1. Posterior sclera flattening. 2. Distention of perioptic sub arachnoid space. 3. Vertical tortuosity of orbital optical nerve. 4. Empty sella turcica. 5. Abnormal cerebellar tonsillar position. 6. Status of transverse venous sinus.

Sample size: 100

Table 1: Distribution of cases based on age wise:

Table 2: Distribution of spectrum of MRI findings

Table 3: Percentage prevalence of BIH findings

Table 4: Most common findings in others group

MRI positivity: Among 100 patients who underwent MRI brain for headache 45 had no obvious abnormality and 55 subjects had abnormal MRI findings. In total of 100,42 are male and 55 are females.

Spectrum of MRI findings: Most of the patients out of 100,45 had normal study. Followed by most prevalent findings are PVIC 11, and BIH 10. Other findings like infections 4, infarct 7, SOL and VAV each 3 cases. Only one case had ICH, in which patient present with acute severe headache.

Out of 100,16 cases had other positive findings, in those most common are sinusitis 5 cases, white matter hyperintensities 4, CSVT 4 and 2 cases showed demyelination changes.

OUT of 10 cases of BIH, most common signs noted are EST and DPSS in 8 cases, followed by PSF 6, VTOON 4, ACTP2 and STVS 3. 

In clinical practice headache is most common condition. MRI would be better because of no radiation hazard and better soft issue resolution. It is essential to exclude underlying cause of headache if any to treat the patient and make the patient comfortable. BIH which is an underdiagnosed cause of headache and is diagnosed confirm with MRI only. In our study among 100 patients who underwent MRI brain for headache 45 had no obvious abnormality and 55 subjects had abnormal MRI findings. In total of 100,42 are male and 55 are females. Followed by most prevalent findings are PVIC 11, and BIH 10. Other findings like infections 4, infarct 7, SOL and VAV each 3 cases. Only one case had ICH, in which patient present with cute severe headache. Out of 100,16 cases had other positive findings, in those most common are Sinusitis in 5, White matter hyperintensities 4, CSVT 4 and 2 cases showed demyelination changes. OUT of 10 cases of BIH, most common signs noted are EST and DPSS in 8 cases, followed by PSF 6, VTOON 4, ACTP2 and STVS 3.  Headache is most common complaint among patients, many headaches are clinically diagnosed and needs imaging to rule out underlying pathology which are treatable. However, imaging showed 45 cases normal, it is necessary to do imaging to rule out any serious causes of headache. On treating the cause, the patient will lead symptom free normal life.

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