소아 청소년 두통 환자에서 뇌영상 검사의 유용성-다기관 연구

The Role of Neuroimaging in Children and Adolescents with Headaches - Multicenter Study

(구연):

Release Date : 2009. 10. 23(금)

Young-Il Rho¹, Hee-Jung Chung², Eun-Sook Suh³, Kon-Hee Lee⁴, Baik-Lin Eun⁵, Sang-Ook Nam⁶, Won-Seop Kim⁷, So-Hee Eun⁸, Young-Ok Kim⁹

1Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea; 2Department of Pediatrics, National Health nsurance Corporation, Ilsan Hospital, Goyang, Korea; 3Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea; 4Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea; 5Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea; 6Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea; 7Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea; 8Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea. 9Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea.

노영일¹, 정희정², 서은숙³, 이건희⁴, 은백린⁵, 남상욱⁶, 김원섭⁷, 은소희⁸, 김영옥⁹

조선대학교 의학전문대학원 소아청소년과학교실¹, 국립의료보험공단 일산병원 소아청소년과², 순천향대학교 의과대학 소아청소년과학교실³,한림대학교 의과대학 소아청소년과학교실⁴,고려대학교 의과대학 소아청소년과학교실⁵,부산대학교 의학전문대학원 소아청소년과학교실⁶, 충북대학교 의과대학 소아청소년과학교실⁷, 고려대학교 의과대학 소아청소년과학교실⁸, 전남대학교 의학전문대학원 소아청소년과학교실⁹

Abstract

Objectives: The aim of this study is to evaluate the role of neuroimaging and to estimate the frequency of intracranial lesions in children and adolescents with headaches. Background: Although headaches in children and adolescents are generally benign, neuroimaging studies are frequently performed in clinical practice for the fear of missing serious underlying diseases. But, neuroimging is rarely necessary unless the history or neurologic examination suggests structural etiologies. A few reports in literature assess the utility of neuroimaging in children and adolescents with headaches. Methods: We retrospectively reviewed the medical records of all 1,562 (male 724, female 838) new patients with headaches in 9 centers of the Pediatric Neurology Clinic of tertiary Hospitals. The mean age was 10.13 years (range 2~18). These patients were evaluated in a comprehensive neurologic examination and data recording age of onset, headache period, frequency, duration, intensity, location and quality of headache and neurologic or headache associated symptoms were obtained. Results: Neuroimaging procedures were performed in 72.8% of the patients. The overall percentage of abnormal findings detected on neuroimaging was 9.3% (112/1,204). The abnormal findings on neuroimaging were 50.0% (9/18) in patients with abnormal neurologic examinations, 12,9% (26/201) in changes in the type of headache and 10.8% (9/83) in neurologic dysfunction and 10.1% (21/208) in imaging for reassurance, 7.0% (12/171) in recent onset of severe headaches. Ten of the patients had undergone surgery because of neuroimaging results. There was no significant relation between abnormality on neuroimaing and age, sex, headache type, onset age of headache, headache period, duration, frequency, location and intensity of headache ( P＞0.05). Conclusions: Neuroimaging procedures in children and adolescents with headaches were very commonly performed. There was a significantly higher abnormality on neuroimaging among the patients with an abnormal neurologic examination ( P0.001). Among patients who underwent neuroimaging because of the recent onset of severe headaches, a change in the type of headache, and/or a neurologic dysfunction, the rate of significant abnormality was very low. We suggest that more strict guidelines for pediatric headache patients are needed.

Keywords: Headache, Neuroimaging, Children and Adolescents