CT Findings of Patients Presenting with Headache at Al Hilla Teaching Hospital

Thamir Jasim Khteir Al Mosawy,Hassanein Ahmed Albaiaty
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Keywords : CT scan, headache, International Headache Society.
Medical Journal of Babylon  14:3 , 2018 doi:1812-156X-14-3
Published :06 January 2018

Abstract

Multislice computed tomography (MDCT) is a promising the important and noninvasive method of detecting head or brain pathology. It is now being widely used in Iraq. To determine the findings of patients presenting with headache (secondary headache) in those with uncertain cause (primary or idiopathic headache) nor uncertain diagnosis by physical examination, laboratory investigations & plain X-ray Al Hilla teaching hospital / Radiology Department / CT scan unit It was cross sectional comparative study conducted in Al Hilla teaching hospital. Total (300) patients were included in the study that underwent MDCT between September 2016 & September 2017 and done by using Siemens Somatom Definition AS, 64 slices which manufactured from 2008 until December 2013, Germany and Philips Brilliance 64 slices, 2008, Holl and to valuate for the cause of headache. The total no. of our patients was (300) patients, males (190), females (110) and no pathology detected 168 (56%) with positive results about 132(44%) the most positive findings are sinusitis (18%), the brain tumors (7,7%), developmental anomalies (6,3%), ischemia (5,3%),brain atrophy (3%), cervicogenic headache (1,3%) and brain metastasis , hemorrhagic infarction each show (1%). MDCT can serve as an excellent screening procedure and non invasive diagnostic procedure, because of its high spatial resolution and ability to image the skull & brain however some cases difficult to diagnose by CT scan alone so need conjugation with other modality like MRI help us to provide a more accurate diagnosis. Contrast media used in some cases to help us in diagnosis.

Introduction

Nowadays the headache is a major complain that seen by doctors in different levels of health care and it’s a major symptoms that make the millions peoples all over the world suffering and affect their life and job. And so it s a one of the main sources of discomfort. Headache is the most common neurological disorders seen in neurology clinics and in emergency units. It is associated but high morbidity but low mortality and mostly working people [1]. Headache with other symptoms consider most prevalent disorders and most frequent symptoms seen in general practice which also associated with personal and societal disability and affect the quality of life, and in addition to the other effects on the financial cost [2] and it is among the top ten causes of disability [3]. Also it is consider as big problem for all societies that affects all ages, and females are more affected than males [4]. In addition its leads impairment of quality of life, and affect and even loss of work [5]. There are many types of headache can be determined by a careful history associated with neurological examination [6]. The world health organization define headache as a symptom of a range of neurobiological disorders, and middle aged adults are the most likely affected but children and old age are also affected [7] .

Materials and methods

This is a cross sectional comparative retrospective study design had been conducted using CT apparatus at Al-Hilla teaching hospital from the 1st of Sep 2016 to the Sep of  2017.
The CT scan exams were done using Siemens Somatom Definition AS, 64 slices which manufactured from 2008 until Dec 2013, Germany and  Philips Brilliance 64 slices, 2008, Holland.
The study was conducted at CT scan unit, Radiology Department Hilla hospital is largest referral and teaching hospital in Babylon governorate. Babylon gover-norate Situated in central Iraq just south of Baghdad, governorate Capital is Hilla, its area about 5,119sq km (1.2% of Iraq) and Population  about 1,728,132  on 2007 and about 2000,000 on 2014  and about more than 6% of total Iraqi population.
Babylon has 14 public hospitals  and hilla teaching hospital is a main public hospital that may examine about more than  90% of whole CT scan exams in Babylon governorate  and offers the following services CT scan, MRI facility, General Radiology, Digital Mammo-graphy and Ultrasound and Ultrasound Interventional Radiology (US guided aspiration of abscesses and renal cysts….etc
It receives referred patients from various referral hospitals in Babylon, as well as outpatient and patient from medical, neurological and emergency units.
      The total no. of our patients was (300) patients, males (190), females (110), and those show  no findings are 168 ( 56%) and those show findings are  132 (44%).




Results

Table shows distribution of sample according the sex. Table shows Patients that show no pathology in brain CT scan according sex and age groups ,Table 16 shows association between CT scan findings including (Sinusitis, Developmental findings, Ischemia, Brain atrophy, Brain tumors, Brain metastasis, Hemorrhagic infarction and Cervical cause (cervicogenic headache) and gender. There was significant association between gender and presence of sinusitis and ischemia.

Discussions

Headache is the most important frequent symptoms that make the patients asking health care and consult medical clinics either public or private clinics in order to know the exact cause of his complain and take suitable treatment for his complain. the Sociodemographic distribution 1-Female (190 patients) (63%) of the total sample are more affected or suffering than male (110 patients) (37%) 2-The age groups (21-30years ) are more affected (79%) and followed by age group (31-40 years) (65 %) which are the age group that more mature and have more life responsibilities. 3-According to the patient job the most affected groups those have no job about (162 patient) (54%) and followed by those have simple job (68) ( 22,6%). 4- According to the educational state the most affected group those have primary education (120 patient) and increase gradually with those higher education . 5- According to the social status the most affected are those have family with more than 3 children (141) (47%) and fallowed by single group (67%) (22, 33%). 6-According to the social class show those low social class are more affected about 182 (60,7%) and followed by middle social class about (78 pt.) (26%) CT scan findings Total number of examined patients are 300. 1- 168 of patients (56%) (primary headache) did not show any significant findings in the CT scan studies that done for them. 2-132 of patients (44%) show CT scan findings (secondary headache). 3-About (152 (50,7%) are presented as acute headache and 148 (49,3%)as chronic headache. 4- the most age group affected in both males 28 (9,3%) and females 55 (18,4%) is (21-30 yrs). 5- Females are more affected than males in all age groups and the most age group show more affected females is (20-30). 6- The commonest findings that seen in patients that examined secondary headache is sinusitis (54) (18%) of total (300 pt.). 7- Sinusitis showed increase in the nasal mucosal thickening and sinuses mucosal wall thickening (both maxillary, frontal ethmoidal sinuses) with or without retention cyst for males are 18 (6% of total), and in females are 11 (3,7%) of total 300 pt. 8- Sinusitis which located in multiple sinuses with nasal septal deviation (13 (4,3% of total) in male and 7 (2,3%) in females. 9- Sinusitis that show mucocele rather than increase in sinus mucosal thickening are 1(0,3 %) for each males & females 10- Sinusitis that show osteoma are 2 (0, 7 %) for males & 1(0, 3%) for females. 11- All age groups are may affected by sinusitis but most group affected is (31-40 yrs) in males & about 9 (3% of total) and in females (21-30 yrs) and (31-40yrs) and about 15 (5%) of total.

References

1. Bahra A, Holland PR. Introduction to the ACNR Headache Series Migraine Patho-physiology. Acnr. 2014;13(7):19–21.
2- American Academy Of Neurology. American Academy of Neurology Multiple Sclerosis Quality Measurement Set. Mult Scler 2014; 1(1):45..
3- Benamer HTS, Deleu D, Grosset D. Epidemiology of headache in Arab countries. J Headache Pain. 2010; 11(1): 1–3.
4- Juni FH, Institutes TM. Prevalence of Headache and its Relation to Absenteeism among a Sample Para-medical Students in Baghdad-Iraq. 2013; 10(3): 552–8.
5- Varanasi U. Prevalence of Headache among Adult Population in. 2016; 10(5): n272–5.
6-Al-umeri KK. Cranial Ct Scan Findings In Patients With Headache. 2010; 6(10): 139–46.
7- World Health Organization. Headache Disorders and Public Health, Education and Management Impications. Neurol Dis Neurosci . 2000.


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