Purpose of Review

We describe a series of cases with unusual brain MRI findings in patients who present with headache disorders.

Recent Findings

Incidental findings in patients imaged for headache include the following: aneurysm, arachnoid cyst, cerebral vascular malformations, Arnold-Chiari malformations, empty sella turcica, gray matter heterotopias, mastoiditis, mega cisterna magna, meningioma, normal variants of cerebral circulation, paranasal sinus disease, pineal cyst, pituitary tumor, Rathke’s cleft cyst, skull hyperostosis, and vestibular schwannoma. The most common abnormal MRI findings encountered in migraine are nonspecific white matter lesions.

Summary

The current 2019 guidelines from the American College of Radiology and American Headache Society recommend against ordering neuroimaging in patients with a high probability of a primary headache disorder not typically associated with diagnostic imaging findings and who have normal neurologic exam in addition to no red flags in history. Often, unnecessary neuroimaging yields incidental findings, and this typically results in patient anxiety and further unnecessary testing. Detailed below are a series of cases in which unusual findings were found in patients presenting to our clinic for further evaluation of headache disorders. Imaging may have been done prior to presentation to us or by us due to concern for secondary causes.

中文翻译：

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头痛影像中异常的脑部MRI发现：一个病例系列。

审查目的

我们描述了一系列出现头痛疾病的患者脑部MRI表现异常的病例。

最近的发现

出现头痛影像的患者的偶然发现包括：动脉瘤，蛛网膜囊肿，脑血管畸形，Arnold-Chiari畸形，空蝶鞍状突突，灰质异位症，乳突炎，巨大水罐，脑膜瘤，脑循环的正常变异，鼻旁窦疾病，松果体囊肿，垂体瘤，Rathke裂囊肿，颅骨肥大和前庭神经鞘瘤。偏头痛中最常见的MRI异常发现是非特异性白质病变。

概要

美国放射医学学院和美国头痛协会的最新2019年指南建议不要对患有原发性头痛疾病的高可能性患者进行神经影像学检查，而原发性头痛疾病通常与诊断性影像学检查结果无关，并且除了历史上没有危险信号外还具有正常的神经系统检查。通常，不必要的神经影像检查会产生偶然发现，这通常会导致患者焦虑并进一步进行不必要的检查。以下详细介绍了一系列病例，这些病例在就诊我们的诊所以进一步评估头痛疾病的患者中发现了异常发现。由于担心次要原因，可能在向我们展示之前或由我们进行了成像。