Pediatric Headache

While imaging patterns of gross structural intracranial abnormalities accounting for headache presentation in the pediatric patients are often conspicuous, recent literature and our daily clinical experience have directed our attention to a relatively more frequent group of overlooked and over lapping entities presenting with headaches in children.

Understanding their etiologies and recognizing their distinct MRI findings can be immensely helpful in managing these patients. We have condensed the subject to seven such etiologies with nonspecific clinical presentation yet distinct associated MRI findings to assist our team and referring physician in accurate radiological diagnosis and optimal patient management. 

DISEASE ENTITY CLINICAL PRESENTATION ETIOLOGY MRI PATTERN
Chairi I malformation short duration occipital/nuchal headaches congenital >5 mm cerebellar tonsillar descent. Complex Chiari 1.5: also brain stem descent with craniocervical junction & osseous dyplasias
Intracranial hypotension orthostatic headache improved in supine position CSF leak, over shunting cerebellar tonsillar ectopia, pachymeningeal enhancement, venous sinus distention, pituitary enlargement, brain/optic chiasm & iter descent
Idiopathic intracranial hypertension variable headaches in obese female altered CSF resorption cerebellar tonsillar ectopia. Papilledema, dilated optic nerve sheaths, empty sella
 
DISEASE ENTITY CLINICAL PRESENTATION ETIOLOGY MRI PATTERN
Vasculopathy without ischemia (moyamoya) migrainous headaches idiopathic stenosis or occlusion of terminal ICA Narrowed or occluded ICA or anterior-mid branches with collaterals at suprasellar, basal ganglia or pial collaterals
Cerebral sinovenous thrombosis headaches, seizure, motor deficits, nausea, vomiting dehydration, infection, malignancy, oral contraceptives, iron deficiency anemia, pseudotumor cerebri, prothrombotic state, chronic systemic disease intra-axial edema/hemorrhage in parasagittal cerebrum, posterotemporal lobe or thalamic distribution with segmental increase in dural sinus CT attenuation
Hemiplegic migrane Hemiparesis with migraine aura, post-ictal confusion mutation of Fe Na/K pump channels (ATP1A2) ; vasospasm/dilatation uniateral reversible edema with altered perfusion
Opthalmoplegic migraine two episodes of headache with paresis of CN III/IV/VI recurrent cranial nerve demyelination/ischemia MRI: CN III thickening and enhancement at the interpenduncular cistem responsive to steroids

I hope this helps better understand the service we offer.

 

A.G Dikengil, M.D Board Certified Radiologist