kids’ korner
left-handed, which in the great majority of cases does not
cause a significant difference in strength from one side to
the other.
An examination of the eyes is mandatory. The only
compressible part of the upper head is the eye and
increased pressure around the brain, called increased
intracranial pressure, can usually be detected by an exam
of the optic disc in the retina (back) of the eye. This
examination involves the use of an ophthalmoscope. If
there is a question of increased intracranial pressure, an
MRI is indicated. Loss of peripheral vision, significant
balance issues, or other abnormalities on the neurologic
exam, can indicate the need for an MRI.
Both CT scans and MRI can be done with contrast
medium – which may be indicated if better visualization
of the blood vessels of the brain is needed. The contrast
medium is injected intravenously and causes the vasculature to be prominent against the background brain tissue.
One might ask, what about checking for a sinus
infection causing the headache? “Wouldn’t an X-ray or
CT scan help you?” First, it is important to recognize that
headache is generally not thought of as a main presenting
sign of sinusitis. Secondly, sinusitis is a clinical diagnosis
based on signs of prolonged nasal drainage (greater than
10 to 14 days) or more severe symptoms of fever and
thick purulent nasal drainage. Both X-rays and CT scans
have been shown to be inaccurate in diagnosing sinus
infections.
It is not usual for parents to tell me that they understand all of the above, but “what would it hurt to do an
MRI? It would put my mind at ease!” While I can empathize with the concerned parent, our first responsibility
is always to do no harm. If a study that is not indicated
is performed and the child has an anxiety attack while in
the machine, or has a reaction to the sedation or contrast
agent, we have not cared for our patient appropriately.
Furthermore, as I stated earlier, it is not uncommon that
MRIs demonstrate abnormalities such as small cysts or a
minor Chiari malformation(in which the bottom of the
brain stem is below the foramen magnum (the hole at
the bottom of the skull). It is thought that 10 percent of
normal individuals may have a Chiari malformation, but
it is often misdiagnosed as the cause of headache.
CT scans and MRI are wonderful tools that without
question have revolutionized imaging of the central
nervous system as well as other parts of the body. They
have become an indispensable part of medical practice,
but that does not mean these scans are indicated in every
case. Any questions about the need for an imaging study
should be thoroughly discussed with your health care
professional. HW
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