Jsmc-10366

COINCIDENTAL FINDINGS OF PARA NASAL SINUS PATHOLOGY IN PATIENT REQUESTED BRAIN MAGNETIC RESONANCE IMAGING FOR HEADACHE

Sana Mohammed Sardar a, and Salah Mohammed Fateh b

a  Kurdistan Board Candidate, Radiology and Medical Imaging Kurdistan Higher Council of Medical Specialties, Kurdistan Region, Iraq.

b College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

Submitted: 16/3/2022; Accepted: 15/7/2022; Published: 21/9/2022

DOI Link: https://doi.org/10.17656/jsmc.10366 

ABSTRACT 

Background 

Headache is a ubiquitous symptom, for which magnetic resonance imaging (MRI) is the primary modality of choice to investigate its underlying causes. Two categories of headache have been well known” primary versus secondary types. Sinus pathology, including sinusitis, is a well-recognized cause of secondary headaches.

Objectives 

A retrospective study was conducted to find the incidence of sinus abnormalities in brain MRI patients presenting with headaches, compare the prevalence of sinus abnormalities versus other structural brain abnormalities at the brain MRI, and categorize the sinus abnormalities into significant and non-significant sinus involvement. In which significant sinus abnormalities might be the cause of headaches.

Methods

A retrospective study at the Sulaymaniyah teaching hospital selected data from brain MRIs of patients with headaches clinically, which were documented on their request paper. First, a Sum of 402 patients (males 157 and females 245) of age (mean age of 40 years) were included in the study from 2021-2022. Patients were grouped according to their imaging findings and specifically sinus abnormality. All statistical analyses were performed on a personal computer with SPSS for Windows (version 27) software.

Results

Four hundred and two cases during 12 months were reviewed; two hundred forty-five patients (60.9%) were female, and one hundred fifty-seven patients (39.1%) were male. Their ages varied from 14 years to 86 years. Approximately 50% of all patients are between the ages of 31 and 50. Sinus abnormalities were the most frequent group (40%), including significant sinus abnormalities of (19,9%), followed by normal brain MR findings (27.8%). 

Conclusion

The majority of patients suffering from headaches have sinus abnormalities on the brain MRI, in which near half of these abnormalities were significant findings, and the second most common imaging findings were normal brain imaging, which was more than the significant sinus abnormalities from here it is advisable for a better revision for the indication of brain MRI in headache, and as a consequence multidisciplinary evaluation of patients with headache should be introduced at an early stage. The team should include a headache specialist and a rhinologist to avoid unnecessary investigations. The significant sinus findings contribute to a substantial number of patients suffering from headaches, thus suggesting the inclusion of sinus findings as a regular part of the radiological reporting template.

KEYWORDS

PNS, MRI, Headache.

References 

1. Ropper AH, Adams RD, Victor M, Brown RH, Victor M. Adams and Victor’s principles of neurology. New York: McGraw-Hill Medical Pub. Division; 2005.

2. Stovner, L. j., Hagen, K., Jensen, R., Katsarava, Z., Lipton, R., Scher, A., Steiner, T., & Zwart, J. A. (2007). The global burden of headache: worldwide documentation of headache prevalence and disability. Cephalalgia: an international journal of headache, 27(3), 193–210. https://doi.org/10.1111/j.1468-2982.2007.01288.x.

3. Evans, R. W. (1996). Diagnostic testing for the evaluation of headaches. Neurologic clinics, 14(1), 1-26.

4. Green, M. W. (2012). Secondary headaches. CONTINUUM: Lifelong Learning in Neurology, 18(4), 783-795.

5. Mechtler, L. L. (2008). Neuroimaging of headaches. CONTINUUM: Lifelong Learning in Neurology, 14(4), 94-117.

6. Dähnert W. Radiology review manual. Lippincott Williams & Wilkins; 2011.

7. Ogolodom MP, Mbaba AN, Abam R, Maduka BU, Nengi A, Wekhe C. Magnetic resonance imaging findings in patients with headaches in Port Harcourt, Rivers State, Nigeria. Journal of Biomedical Sciences. 2019;8(3).

8. Gryglas-Dworak A, Nowaczewska M, Bro zek-Madry E, Martelletti P. Etiology of ‘Sinus Headache’—Moving the Focus from Rhinology to Neurology. A Systematic Review. Brain Sci. 2021, 11, 79.

9. Ashraf, N., & Bhattacharyya, N. (2001). Determination of the "incidental" Lund score for the staging of chronic rhinosinusitis. Otolaryngology--head and neck surgery: official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 125(5), 483–486. https://doi.org/10.1067/mhn.2001.119324

10. Nazri M, Bux SI, Tengku-Kamalden TF, Ng KH, Sun Z. Incidental detection of sinus mucosal abnormalities on CT and MRI imaging of the head. Quantitative Imaging in Medicine and Surgery. 2013 Apr;3(2):82-8.

11. Itanyi, U. D., Okere, P. C., Iloanusi, N. I., & Uduma, F. U. (2020). Magnetic resonance imaging in chronic headache: our experiences and perspectives. African health sciences, 20(3), 1496–1506.

12. Hansen AG, Stovner LJ, Hagen K, Helvik AS, Thorstensen WM, Nordgård S, Bugten V, Eggesbø HB. Paranasal sinus opacification in headache sufferers: A population-based imaging study (the HUNT study-MRI). Cephalalgia. 2017 May;37(6):509-16.

13. Maharjan S. Assessment of paranasal sinuses in Magnetic Resonance Imaging of brain. Bangabandhu Sheikh Mujib Medical University Journal. 2016 Aug 17;9(2):104-6.

14. Cain, M. R., Arkilo, D., Linabery, A. M., & Kharbanda, A. B. (2018). Emergency Department Use of Neuroimaging in Children and Adolescents Presenting with Headache. The Journal of paediatrics, 201, 196–201.

15. Wang R, Liu R, Dong Z, Su H, Ao R, Liu Y, Wang Y, Ma L, Yu S. Unnecessary neuroimaging for patients with primary headaches. Headache: The Journal of Head and Face Pain. 2019 Jan;59(1):63-8.

16. Young, N. P., Elrashidi, M. Y., McKie, P. M., & Ebbert, J. O. (2018). Neuroimaging utilization and findings in headache outpatients: Significance of red and yellow flags. Cephalalgia: an international journal of headache, 38(12), 1841–1848.

17. Frishberg B. M. (1994). The utility of neuroimaging in evaluating headache in patients with normal neurologic examinations. Neurology, 44(7), 1191–1197.

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