Medical film boutique Imaging manifestations of acute headache

Acute headache is a common symptom and is due to headache
in about 2% to 4% of patients presenting in the emergency department.
Headache is the first symptom of many diseases, so obtaining a complete clinical history of the patient can help radiologists make the right judgment
.
The onset, duration, severity, risk factors (e.
g.
, history of hypertension, immunosuppression, or malignancy), and associated focal neurologic or systemic symptoms may help the radiologist decide which imaging method is more appropriate
.

Imaging is more likely to be abnormal in patients with "lightning-strike" headache than in other patients with mild headache
.
Acute headache has a variety of causes, including subarachnoid hemorrhage (ruptured aneurysm, reversible vasoconstriction syndrome, or pituitary tumor stroke), cerebral parenchymal hemorrhage (hypertension, arteriovenous malformation rupture, cerebral amyloid angiopathy, dural arteriovenous fistula, or cerebral venous sinus embolism), cerebral parenchymal edema (reversible posterior encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, cerebral venous sinus embolism, encephalitis).

Changes in intracranial pressure associated with spontaneous intracranial hypertension, spontaneous intracranial hypertension, prior lumbar puncture, or epidural injection may have specific radiographic findings
.

For increased knowledge of the pathophysiology of diseases, radiologists play an important role
in making the correct diagnosis.
The various causes of acute headache are described below, along with associated imaging findings
.

Aneurysm, 64-year-old woman, lightning headache
.
(Panel a) Axial non-contrast CT shows subarachnoid hemorrhage in the basal cistern, (Panel b) Coronary CT angiography shows an aneurysm at the bifurcation of the right middle cerebral artery (thick black arrow), and an aneurysm of the anterior communicating artery (black thin arrow).

(C) Plain scan magnetic resonance vessel wall imaging, (D diagram) enhanced magnetic resonance vascular wall imaging, showing wall strengthening (white thick arrow)
of the hemangiomas at the bifurcation of the right middle cerebral artery.
The aneurysm in the anterior communicating artery is not strengthened (picture not shown).

Ruptured cystic aneurysm, 52-year-old woman with a history of Crohn's disease, opiate use, and humeral osteomyelitis, headache and altered
mental status.
A sac-shaped aneurysm originating from the M2 segment of the left middle cerebral artery ruptures, and medium-sized intraparenchymal hemorrhage
in the left temporal lobe is seen.

Acute subarachnoid hemorrhage, 44-year-old woman with a history of alcoholic hepatitis, elevated international normalized ratio, emergency department
presentation for headache after a fall.
Axial non-contrast CT showed acute subarachnoid hemorrhage in the interfoot cistern of the brain, and no clear aneurysm on CT angiography, and the patient subsequently recovered
completely.

Typical site
of hypertensive intracerebral parenchymal hemorrhage.
Axial non-contrast CT shows that the bleeding sites are located in the basal ganglia (figure a), pons (figure b), thalamus (figure c), cerebellum (figure d).

Intraparenchymal hematoma, a 72-year-old man, presents to the emergency department
with headache and abnormal mental status.
(A) Axial non-contrast CT showed a cerebral parenchymal hematoma in the right parietal lobe, and (Panel B) Axial SWI of the same patient several months ago showed multiple subcortical microhemorrhage foci, especially the right parietal occipital lobe junction
.

Imoid dural arteriovenous fistula, 62-year-old man with a history of hypertension, hyperlipidemia and diabetes, presents to the emergency department
with headache, confusion and sweating.
(Figure a) Axial non-contrast CT showed a right frontal hematoma and a significantly high-density cortical vein
.
(b) CT vascular imaging shows dilated and curved veins, arranged along the bilateral frontal and right temporal parts, showing multiple venous aneurysm-like dilatations, one of which is adjacent to the bleeding site
of the right frontal lobe.
(C) Traditional angiography shows a dural arteriovenous fistula of the ethmoid bone, fed by a branch vessel with hyperplasia of the internal mandibular artery, with superficial venous drainage, and bilateral dilated veins drained to bilateral Labbe veins
.

Blood accumulates behind the slope, a 43-year-old woman presents to the emergency department
with a sudden headache.
(a) Axial non-contrast CT, (b) sagittal non-contrast CT shows blood accumulation behind the slope across the occipital cartilage symphysis, along the posterior dural distribution pattern (long black arrow), and the patient subsequently recovered without any complications
.

Reversible cerebral vasoconstriction syndrome (RCVS), a 21-year-old woman presenting to the emergency department
with headaches.
The left frontoparietal lobe is hemorrhage, with high-density opacities (a-figure, axial plain CT, white long arrow), and the corresponding high-intensity opacities of the left frontopatoparietal lobe (b-figure, axial FLAIR).

(C figure) magnetic resonance angiography, showing vasoconstriction (long white arrow) in the M1 segment of bilateral middle cerebral arteries and A1 segment of bilateral anterior cerebral arteries, (d figure) Magnetic resonance angiography for later follow-up review, vasoconstriction disappeared
.
A review of the patient's medication history showed that the patient had used a selective serotonin reuptake inhibitor.

Posterior reversible encephalopathy syndrome (PRES), 45-year-old man with a history of kidney transplantation and hypertension, presents with headache
.
Axial FLAIR showed bilateral occipital gyrus and paracortical white matter hyperintensity, and the patient was diagnosed with PRES, and the imaging findings resolved
after reexamination.

Parenchymal hemorrhage, 68-year-old woman with history of hypertension, presenting with headache
.
Axial non-contrast CT shows left parietal brain parenchymal hemorrhage
.

Subarachnoid hemorrhage, 48-year-old man with history of end-stage renal disease, presenting with headache
.
(A) Axial FLAIR showed abnormally hyperintense opacities in both cerebellar hemispheres, and (b) axial SWI showed subarachnoid hemorrhage
.

Cerebral vein embolism (CVT), a 57-year-old man, was admitted to the emergency department with headache and loss of consciousness, and (a) axial non-contrast CT showed bilateral frontal lobe parenchymal hemorrhage, with a symmetric distribution
.
(b) Axial CT venous imaging showing filling defects of the superior sagittal sinus (long black arrows).

Spontaneous internal carotid artery dissection, 39-year-old woman, headache and neck pain for 2 weeks
.
CT angiography reconstruction shows a long and distal tapering
of the right internal carotid artery from the midsection to the base of the skull.
(I=down, S=top)

Vertebral artery dissection (VAD), a 37-year-old woman presents to the emergency department with right-sided headache and neck pain, and initial non-contrast CT (not shown) is negative
.
CT angiography of the neck shows luminal stenosis and irregular walls of the left vertebral artery transverse and atlantovertebral segments (long black arrows).

Internal carotid artery dissection, 37-year-old woman presents with headache and left-sided neck pain
.
Initial non-contrast CT (not shown) is negative
.
Axial plain scan T1WI lipid compression magnetic resonance angiography shows crescent-shaped T1WI high-intensity intermural hematoma along the left internal carotid artery
.
A positive crescent sign (long white arrow) is more common
in internal carotid artery dissection than vertebral artery dissection.

Toxoplasmosis, 45-year-old man with a history of HIV infection, CD4 cell count23, presents to the emergency department
with headache confusion.
(a) The initial axial flat scan CT shows a large area of low-density shadow centered on the left basal ganglia, with mass effect, and pushes the midline to the
right.
(b) Axial FLAIR showed hyperintense lesions, and PCR results confirmed the diagnosis
of toxoplasmosis.

Herpes simplex virus type 1 encephalitis, 93-year-old woman presents to the emergency department
with headaches.
(a) The initial axial flat scan CT showed a slightly lower density opacity on the anteromedial side of the right temporal lobe, and (b) the axial FLAIR showed the corresponding abnormally high signal opacity on the anteromedial side of the right temporal lobe, as well as the abnormally high signal opacity
on the parahippocampal gyrus.
The lumbar puncture results confirm the diagnosis
.

Meningitis, a 32-year-old man, has a 1-week sinus foreign body sensation, followed by right ear pain, hearing loss, and secretory outflow
.
(a) Axial CT bone window shows the right mastoid air chamber, mastoid sinus, tympanic cavity and gasified petrous apex diffuse soft tissue density shadows
.
(b) The axial position T2WI shows a wide range of liquid signal shadows
at the corresponding part.

Spontaneous intracranial hypertension, 38-year-old woman presents with headache and visual changes
.
(a) Coronal T2WI shows an enlarged sella with a partially empty sella (long white arrow), and (b) axial lipid pressure T1WI shows bilateral optic nerve sheath dilation (long white arrow).

Spontaneous cranial hypotension, 76-year-old woman presents with
headache diplopia.
(a) Axial FLAIR shows high-intensity subdural fluid accumulation
covering both convex surfaces of the brain.
(B) Axial enhanced magnetic resonance shows mild diffuse enhancement
of the dura.
Magnetic resonance of the whole spine shows subdural fluid accumulation in the lumbar spine (not shown).