Arteriography As an invasive and often unavailable study, arteriography is rarely the initial angiographic evaluation performed in children with thunderclap headache. A study in 2011 by Sabri et al [47] evaluated patients that presented with intracranial hemorrhage, predominantly SAH. Their findings showed that the yield from CTA and arteriography are relatively comparable, but that arteriography is superior in detection of aneurysm. Hence, in cases in which the CTA result was found to be normal despite high suspicion for lesion in the setting of SAH, a follow-up CTA or arteriography is considered useful. However, use of CTA over arteriography has been controversial. In 2007, Kallmes et al [45] declared that because both negative and positive CTA scans mandate subsequent conventional angiography, the CTA should be dispensed with and patients should proceed directly to arteriography. Furthermore, Moran et al [46] declared that conventional angiography with arteriography is the ideal method for imaging these patients because of its ability to detect aneurysms quickly, reliably, and safely and that it guides the prompt proper therapy. The applicability of these adult-based studies to the pediatric population is debatable. MRI In a study by Lateef et al [1], the overwhelming majority of acute headaches in children and adolescents were attributable to common, minor, transient conditions, such as upper respiratory illness. Headache is the most common symptom identified with the intracranial spread of infection resulting from dural irritation and localized encephalitis. The headache can be attributed to either intracranial or extracranial infections. In the setting of suspected intracranial infection, the need for neuroimaging is guided by laboratory tests and clinical signs [51]. Clinical signs suggesting intracranial abnormality include high fever and change in mental status with and without focal signs.
Headache Child PCAs. Arteriography As an invasive and often unavailable study, arteriography is rarely the initial angiographic evaluation performed in children with thunderclap headache. A study in 2011 by Sabri et al [47] evaluated patients that presented with intracranial hemorrhage, predominantly SAH. Their findings showed that the yield from CTA and arteriography are relatively comparable, but that arteriography is superior in detection of aneurysm. Hence, in cases in which the CTA result was found to be normal despite high suspicion for lesion in the setting of SAH, a follow-up CTA or arteriography is considered useful. However, use of CTA over arteriography has been controversial. In 2007, Kallmes et al [45] declared that because both negative and positive CTA scans mandate subsequent conventional angiography, the CTA should be dispensed with and patients should proceed directly to arteriography. Furthermore, Moran et al [46] declared that conventional angiography with arteriography is the ideal method for imaging these patients because of its ability to detect aneurysms quickly, reliably, and safely and that it guides the prompt proper therapy. The applicability of these adult-based studies to the pediatric population is debatable. MRI In a study by Lateef et al [1], the overwhelming majority of acute headaches in children and adolescents were attributable to common, minor, transient conditions, such as upper respiratory illness. Headache is the most common symptom identified with the intracranial spread of infection resulting from dural irritation and localized encephalitis. The headache can be attributed to either intracranial or extracranial infections. In the setting of suspected intracranial infection, the need for neuroimaging is guided by laboratory tests and clinical signs [51]. Clinical signs suggesting intracranial abnormality include high fever and change in mental status with and without focal signs.