In infants, SDE is most commonly a complication of purulent meningitis, whereas in older children the source of SDE is typically direct extension of sinusitis or otitis media into the extracranial spaces. MRI can help identify epidural empyemas because of its ability to distinguish between different types of fluid, especially with use of diffusion- weighted imaging. Acute meningitis is a common neurological emergency and the diagnosis is usually made based on clinical and laboratory findings. CT Neuroimaging is reserved for specific adverse features, such as prompt diagnosis of SAH, or underlying causes, such as mastoiditis. Neurologic signs and symptoms such as nuchal rigidity or alteration in consciousness may be indications for imaging with CT. However, the sensitivity of CT in diagnosing pediatric encephalitis in comparison to MRI is generally poor [52]. In the emergency setting, CT may be indicated in evaluating children with suspected intracranial infection, often performed prior to lumbar puncture. IV contrast is recommended in these patients if MRI is not rapidly available. A negative noncontrast CT scan of the head should not conclude the evaluation for suspected encephalitis. In a study by Bykowski et al [52], cranial CTs were the initial study in 94 patients, and abnormal findings were present in 22. An additional 26 children had a normal acute CT and abnormal findings identified on MRI performed within 2 days [52]. CTA The role for CTA is limited in children with headache attributed to infection unless SAH or stroke is suspected and MRI/MRA is not possible. CTV As children with mastoiditis are at particularly high risk for venous sinus thrombosis, CTV may be helpful in the evaluation of these patients. Children with sphenoid sinusitis are also at risk for cavernous sinus thrombosis, and CTV may be helpful in these patients. MRA The role for MRA is limited in children with headache attributed to infection unless SAH or stroke is suspected.
Headache Child PCAs. In infants, SDE is most commonly a complication of purulent meningitis, whereas in older children the source of SDE is typically direct extension of sinusitis or otitis media into the extracranial spaces. MRI can help identify epidural empyemas because of its ability to distinguish between different types of fluid, especially with use of diffusion- weighted imaging. Acute meningitis is a common neurological emergency and the diagnosis is usually made based on clinical and laboratory findings. CT Neuroimaging is reserved for specific adverse features, such as prompt diagnosis of SAH, or underlying causes, such as mastoiditis. Neurologic signs and symptoms such as nuchal rigidity or alteration in consciousness may be indications for imaging with CT. However, the sensitivity of CT in diagnosing pediatric encephalitis in comparison to MRI is generally poor [52]. In the emergency setting, CT may be indicated in evaluating children with suspected intracranial infection, often performed prior to lumbar puncture. IV contrast is recommended in these patients if MRI is not rapidly available. A negative noncontrast CT scan of the head should not conclude the evaluation for suspected encephalitis. In a study by Bykowski et al [52], cranial CTs were the initial study in 94 patients, and abnormal findings were present in 22. An additional 26 children had a normal acute CT and abnormal findings identified on MRI performed within 2 days [52]. CTA The role for CTA is limited in children with headache attributed to infection unless SAH or stroke is suspected and MRI/MRA is not possible. CTV As children with mastoiditis are at particularly high risk for venous sinus thrombosis, CTV may be helpful in the evaluation of these patients. Children with sphenoid sinusitis are also at risk for cavernous sinus thrombosis, and CTV may be helpful in these patients. MRA The role for MRA is limited in children with headache attributed to infection unless SAH or stroke is suspected.