These children are at risk for posterior reversible encephalopathy syndrome, especially after a bone marrow transplant, and for SAH, especially in the setting of arterial aneurysm. A history of stroke, transient ischemic attack, seizures, neurological symptoms, focal neurological examination, or elevated platelet counts at presentation warrants confirmatory imaging studies [38]. MRI is the imaging modality of choice in these children because of its superior sensitivity for infarction and other parenchymal abnormalities. Seizures are one of the most common secondary etiologies for headache and often have auras similar to some migraines [39]. MRI without IV contrast is indicated in the evaluation of patients with seizures. CTA If an acute stroke is suspected, CTA in conjunction with a noncontrast CT scan of the head is indicated, with MRI/MRA the preferred modality because of its greater sensitivity in detecting acute stroke versus CT. CT should not be delayed if MRI is not available or feasible. CTA of the head and neck are usually indicated if there is strong suspicion for arterial dissection. If MRA is performed initially to evaluate for arterial dissection and is inconclusive, CTA may be helpful for further evaluation. CTV If there is concern for venous outflow obstruction, such as in the setting of venous sinus thrombosis or PTCS, CTV has been found to be an alternative approach with high sensitivity and specificity in detecting venous sinus thrombosis compared with MRV [25]. MRV remains the imaging study of choice over CTV in children. MRA MRI is more sensitive for detecting early changes of a stroke, and a concurrent MRA plays an important role in stroke imaging. MRA is indicated for children with sickle cell anemia in the setting of headache. MRV In conjunction with MRI, MRV is indicated in patients with possible venous sinus abnormalities, such as those with suspected PTCS. Decreased spinal canal compliance has been identified in patients with PTCS [40].
Headache Child PCAs. These children are at risk for posterior reversible encephalopathy syndrome, especially after a bone marrow transplant, and for SAH, especially in the setting of arterial aneurysm. A history of stroke, transient ischemic attack, seizures, neurological symptoms, focal neurological examination, or elevated platelet counts at presentation warrants confirmatory imaging studies [38]. MRI is the imaging modality of choice in these children because of its superior sensitivity for infarction and other parenchymal abnormalities. Seizures are one of the most common secondary etiologies for headache and often have auras similar to some migraines [39]. MRI without IV contrast is indicated in the evaluation of patients with seizures. CTA If an acute stroke is suspected, CTA in conjunction with a noncontrast CT scan of the head is indicated, with MRI/MRA the preferred modality because of its greater sensitivity in detecting acute stroke versus CT. CT should not be delayed if MRI is not available or feasible. CTA of the head and neck are usually indicated if there is strong suspicion for arterial dissection. If MRA is performed initially to evaluate for arterial dissection and is inconclusive, CTA may be helpful for further evaluation. CTV If there is concern for venous outflow obstruction, such as in the setting of venous sinus thrombosis or PTCS, CTV has been found to be an alternative approach with high sensitivity and specificity in detecting venous sinus thrombosis compared with MRV [25]. MRV remains the imaging study of choice over CTV in children. MRA MRI is more sensitive for detecting early changes of a stroke, and a concurrent MRA plays an important role in stroke imaging. MRA is indicated for children with sickle cell anemia in the setting of headache. MRV In conjunction with MRI, MRV is indicated in patients with possible venous sinus abnormalities, such as those with suspected PTCS. Decreased spinal canal compliance has been identified in patients with PTCS [40].