Tehran University Medical Journal

Background: Headache is one of the most common problems that bring patients to doctors' offices. Many physicians order neuroimaging studies after taking the history of the patient and performing a physical examination. These neuroimaging studies are often requested due to the probable existence of an intracranial lesion. However, at times they are requested to allay the fears of patients or even doctors. Most of these studies are normal and the question arises whether there is any indication for requesting neuroimaging studies for a patient with an isolated headache.

Methods: We studied 146 patients with headache who had been referred for CT scan to the imaging center of Imam Khomeini Hospital during 2004-2005. For each patient, a questionnaire, including the medical history and accompanying neurological symptoms, was filled out and CT scan results were gathered.

Results: The mean of age of the patients was 37.8 years, and 69% were female. Only 10 patients (6.8%) had a brain lesion in the CT scan. Accompanying neurological symptoms were more frequent in patients with abnormal rather than normal CT scans. There was a meaningful correlation between abnormal CT scan and paresthesia, ptosis, paresia, diplopia, visual loss, convulsion, vomiting and vertigo. A statistical correlation existed between gender and positive CT scan.

Conclusions: Many patients with headache have normal brain CT scan results. Thus, better criteria are warranted for requesting neuroimaging including accurate patient history and neurological examination in order to prevent unnecessary radiation exposure. MRI instead of CT scan would be a better first step toward the evaluation of the possible existence of brain lesions.

Background: Intracranial lipomas are rare benign neoplasms that comprise 1% of all primary brain tumors. Generally, occur in midline structure and usually identified incidentally on CT scans or in autopsies. The incidence of intracranial lipomas is about 0.08 to 0.46% on autopsies. These benign lesions are slow-growing, usually asymptomatic and rarely require surgery.

Case Presentation: We report a 20 years old male who complained of headache since two years ago. On CT examination, a quadrigeminal cistern lipoma without any pressure effect on neural structures demonstrated. His headache remitted with conservative measures. Here, we have a review on the literature and explain CT scan and MRI findings.

Conclusion: According to the literature and present case, it seems that direct surgical excision of tumor is not justified in the majority of cases and symptoms of patients greatly respond to conservative measures and, at most, in cases of hydrocephalus, CSF shunting relieves their symptoms.