Abnormal computed tomography (CT) brain findings in adult patients presenting with the chief complaint of headache
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Abstract
Objective: To determine abnormal computed tomography (CT) findings in adult patients presenting with the chief complaint of headache without preceding trauma and focal neurological signs.
Methods: A cross-sectional study was conducted at PAC Hospital Kamra from November 4, 2024, to May 4, 2025, enrolling 161 patients aged 18-80 years with headache after obtaining informed consent using non-probability consecutive sampling. Non-contrast CT scans were performed using a 160-slice scanner with contrast-enhanced imaging if indicated. Abnormalities, including space-occupying lesions, paranasal sinus disease, hydrocephalus, intracranial hemorrhage, cerebral infarcts, age-inappropriate cerebral atrophy, dural venous sinus thrombosis, and miscellaneous findings, were recorded. Data was analyzed using SPSS Version 26.
Results: The mean age was 40.5 ± 15.54 years, with 98 females (60.87%) and 63 males (39.13%). The median duration of headache was 12 weeks, and the interquartile range (IQR) of 2–48 weeks (range, 1-96 weeks). Abnormal CT findings were observed in 43 patients (26.7%), including space-occupying lesions in 2 (1.24%), paranasal sinus disease in 30 (18.63%), hydrocephalus in 2 (1.24%), cerebral infarcts in 4 (2.48%), and miscellaneous findings in 5 (3.11%). No age-inappropriate cerebral atrophy, intracranial haemorrhage, or dural venous sinus thrombosis were detected in any of the patients.
Conclusion: Abnormal CT findings were uncommon in adults with non-traumatic headache and no neurological deficits. Paranasal sinus disease was the most frequent abnormality. Selective imaging based on clinical risk factors can reduce unnecessary CT usage.
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References
1. Gorleku PN, Dzefi-Tettey K, Edzie EKM, Setorglo J, Piersson AD, Ofori IN, et al. The degree and appropriateness of computed tomography utilization for diagnosis of headaches in Ghana. Heliyon 2021;7(4):e06722. https://doi.org/10.1016/j.heliyon.2021.e06722
2. Rhudy C, Schadler A, Huffmyer M, Porter L. Rural disparities in emergency department utilization for migraine care. Headache 2024;64(1):37-47. https://doi.org/10.1111/head.14659
3. Lemmens CMC, van der Linden MC, Jellema K. The value of cranial CT imaging in patients with headache at the emergency department. Front Neurol 2021;12:e663353. https://doi.org/10.3389/fneur.2021.663353
4. Raza S, Syed TM, Siddiqi HA. Computerised tomographic scanning for headache. Pak Armed Forces Med J 2010;60(3):427-30. https://pafmj.org/PAFMJ/article/view/1458
5. Simwatachela E, Ozoh JO, Mabuza LH, Kalinda C. Clinical predictors of abnormal head computed tomography findings in non-trauma patients presenting to a South African emergency department. Front Radiol 2021;1:e759731. https://doi.org/10.3389/fradi.2021.759731
6. Rai GS, Rai T, Jain L, Vyas MM, Roshan R. Evaluation of CT and MRI findings among patients presented with chief complaint of headache in central India. J Clin Diagn Res 2016;10(2):TC21-25. https://doi.org/10.7860/JCDR/2016/16852.7249
7. Whiteley WN, MacRaild A, Wang Y, Dennis M, Al-Shahi Salman R, Gray A, et al. Clinical diagnosis and magnetic resonance imaging in patients with transient and minor neurological symptoms: a prospective cohort study. Stroke 2022;53(11):3419-28. https://doi.org/10.1161/STROKEAHA.122.039082
8. Malik MMUD, Alqahtani M, Hadadi I, AlQhtani AG, Alqarni A. An analysis of computed tomography diagnostic reference levels in India compared to other countries. Diagnostics 2024;14(15):e1585. https://doi.org/10.3390/diagnostics14151585
9. Albertini GM, Malbon A, Staudacher A, Stabile F. Clinical, magnetic resonance imaging, and histological description of a choroid plexus papilloma with disseminated intraventricular and spinal cerebrospinal fluid drop metastases in a young adult dog: A case report. Front Vet Sci 2023;10:e1223729. https://doi.org/10.3389/fvets.2023.1223729
10. Mohamed SW, Libda IA, Ismail HAH, Gabal MMI. Computed tomography imaging in orbital complications of acute inflammatory paranasal sinuses diseases. Egypt J Hosp Med 2022;88(1):2812-9. https://dx.doi.org/10.21608/ejhm.2022.242274
11. Lee D, Kim ES, Lee Y, Lee SM, Yoon DY, Ju Y-S, et al. Changes in computed tomography perfusion parameters and maximum contrast enhancement in patients having hydrocephalus with a ventriculoperitoneal shunt: A pilot study. Acta Radiologica 2022;63(10):1398-405. https://doi.org/10.1177/02841851211038807
12. Wu Q, Che W, Chen N, Wang L, Ren S, Ye F, et al. Is the hyperdensity areas of the CT blend sign associated with the fresh bleeding in intracerebral hemorrhage? Curr Med Imaging 2024;20(1):e15734056310498. https://doi.org/10.2174/0115734056310498241017052529
13. Öksüzler M, Polat S, Tunç M, Vuralli D, Göker P. Evaluation of the brain indexes of subjects with and without brain atrophy using computed tomography. J Anat Soc India 2022;71(4):295-302. https://doi.org/10.4103/jasi.jasi_20_22
14. Chiewvit P, Tritrakarn S-o, Nilanont Y. Accuracy of noncontrast CT brain in detection of cerebral venous sinus thrombosis. Int J Clin Med 2021;12(11):471-83. https://doi.org/10.4236/ijcm.2021.1211043
15. Hansen AG, Stovner LJ, Hagen K, Helvik AS, Thorstensen WM, Nordgård S, et al. Paranasal sinus opacification in headache sufferers: a population-based imaging study (the hunt study-mri). Cephalalgia 2017;37(6):509-16. https://doi.org/10.1177/0333102416651455
16. Plawecki AM, Saleem A, Zvirbulis D, Peterson EL, Yoo F, Ali A, et al. Clinical features and headache diagnoses in patients with chief complaint of craniofacial pain. Ann Otol Rhinol Laryngol 2023;132(6):628-37. https://doi.org/10.1177/00034894221111254
17. Mudgil SP, Wise SW, Hopper KD, Kasales CJ, Mauger D, Fornadley JA. Correlation between presumed sinusitis-induced pain and paranasal sinus computed tomographic findings. Ann Allergy Asthma Immunol 2002;88(2):223-6. https://doi.org/10.1016/s1081-1206(10)62000-5
18. Kalidindi S, Gandhi S. Prevalence of sinus mucosal abnormalities on CT of the head performed for headache when compared with those performed for other indications. Cureus 2024;16(3):e56608. https://doi.org/10.7759/cureus.56608
19. Nesselroth D, Klang E, Soffer S, Druskin E, Barash Y, Hoffmann C, et al. Yield of head CT for acute findings in patients presenting to the emergency department. Clin Imaging 2021;73:1-5. https://doi.org/10.1016/j.clinimag.2020.11.025
20. Moodley S, Bhigjee AI. The association between headache presentation, normal examination and neuroimaging findings: A retrospective analysis of patients presenting to a tertiary referral centre. Afr Health Sci 2022;22(4):261-72. https://doi.org/10.4314/ahs.v22i4.31
21. Krishnaswamy D, HV P, Mohammed M. A study on the value of multislice multidetector computed tomography of the brain in individuals with primary and secondary headaches in a tertiary care hospital. Eur J Cardiovasc Med 2025;15(1): 305-12. https://doi.org/10.5083/ejcm/25-01-49
22. Alimohammadi H, Zareh Shahamati S, Karkhaneh Yousefi A, Safarpour Lima B. Potentially inappropriate brain CT-scan requesting in the emergency department: A retrospective study in patients with neurologic complaints. Acta Biomed 2021;92(5):e2021302. https://doi.org/10.23750/abm.v92i5.10209
23. Shamshad L, Akhtar M, Shafeeq M, Tanwani K, Memon S, Sethar S. Computed tomography head scan to evaluate patient with chief complaint of headache: Is it necessary and cost-effective? Med Forum Mon 2022;33(2):65-9.
24. Mahmood S. CT scan evaluation of patients presenting with headache and weakness. Planet 2023;7(02):49-53.