Less common causes of TCH include cerebral venous thrombosis (CVT), cervical arterial dissection, posterior reversible encephalopathy syndrome (PRES), spontaneous intracranial hypotension (SIH), pituitary apoplexy, perimesencephalic hemorrhage, arteriovenous malformations (AVM), dural arteriovenous fistulas, and intraventricular colloid cyst. A subset of patients will not have a causative disorder and will be diagnosed as suffering from primary TCH; this is a diagnosis of exclusion [10,11,13]. Arteriography Cervicocerebral There is no relevant literature to support the use of cervicocerebral arteriography in the initial evaluation of TCH; it may have utility in follow-up evaluation after initial neuroimaging. Digital subtraction angiography (DSA) can assess vessel diameters as small as 0.4 mm compared with 0.7 mm for CT angiography (CTA). This may be useful for further workup of etiologies such as RCVS, which primarily impacts the smaller vessels and provides the opportunity for intravascular therapy. For example, intraarterial nimodipine has been used to demonstrate reversibility, a diagnostic criterion for RCVS [12]. Likewise, DSA may have a role in the workup of aneurysm rupture associated with SAH, when no aneurysm is detected on the initial multidetector CTA. The American Heart Association and the American Stroke Association guidelines also suggest that DSA may not be necessary if a classic perimesencephalic pattern of hemorrhage is present on CT with a negative CTA. In cases of suspected CVT or AVM based on initial neuroimaging, catheter angiography may be used for further characterization and for endovascular therapy [11]. CT Head With IV Contrast There is no relevant literature to support the use of CT head with intravenous (IV) contrast in the initial imaging evaluation of TCH. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT head without and with IV contrast in the initial imaging evaluation of TCH. Headache
Headache PCAs. Less common causes of TCH include cerebral venous thrombosis (CVT), cervical arterial dissection, posterior reversible encephalopathy syndrome (PRES), spontaneous intracranial hypotension (SIH), pituitary apoplexy, perimesencephalic hemorrhage, arteriovenous malformations (AVM), dural arteriovenous fistulas, and intraventricular colloid cyst. A subset of patients will not have a causative disorder and will be diagnosed as suffering from primary TCH; this is a diagnosis of exclusion [10,11,13]. Arteriography Cervicocerebral There is no relevant literature to support the use of cervicocerebral arteriography in the initial evaluation of TCH; it may have utility in follow-up evaluation after initial neuroimaging. Digital subtraction angiography (DSA) can assess vessel diameters as small as 0.4 mm compared with 0.7 mm for CT angiography (CTA). This may be useful for further workup of etiologies such as RCVS, which primarily impacts the smaller vessels and provides the opportunity for intravascular therapy. For example, intraarterial nimodipine has been used to demonstrate reversibility, a diagnostic criterion for RCVS [12]. Likewise, DSA may have a role in the workup of aneurysm rupture associated with SAH, when no aneurysm is detected on the initial multidetector CTA. The American Heart Association and the American Stroke Association guidelines also suggest that DSA may not be necessary if a classic perimesencephalic pattern of hemorrhage is present on CT with a negative CTA. In cases of suspected CVT or AVM based on initial neuroimaging, catheter angiography may be used for further characterization and for endovascular therapy [11]. CT Head With IV Contrast There is no relevant literature to support the use of CT head with intravenous (IV) contrast in the initial imaging evaluation of TCH. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT head without and with IV contrast in the initial imaging evaluation of TCH. Headache