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{{Radiation injury}}
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==Differentiating Radiation injury From Other Diseases==
[[Radiation injury]] should be differentiated from other [[diseases]] causing severe [[headache]] for example: <ref>{{Cite journal
| author = [[Endrit Ziu]] & [[Fassil Mesfin]]
| title = Subarachnoid Hemorrhage
| year = 2017
| pmid = 28722987
}}</ref><ref>{{Cite journal
| author = [[Benedikt Schwermer]], [[Daniel Eschle]] & [[Constantine Bloch-Infanger]]
| title = &#91;Fever and Headache after a Vacation in Thailand&#93;
| journal = [[Deutsche medizinische Wochenschrift (1946)]]
| volume = 142
| issue = 14
| pages = 1063–1066
| year = 2017
| doi = 10.1055/s-0043-106282
| pmid = 28728201
}}</ref><ref>{{Cite journal
| author = [[Otto Rapalino]] & [[Mark E. Mullins]]
| title = Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies
| journal = [[Neurosurgery]]
| year = 2017
| doi = 10.1093/neuros/nyx201
| pmid = 28575459
}}</ref><ref>{{Cite journal
| author = [[I. B. Komarova]], [[V. P. Zykov]], [[L. V. Ushakova]], [[E. K. Nazarova]], [[E. B. Novikova]], [[O. V. Shuleshko]] & [[M. G. Samigulina]]
| title = &#91;Clinical and neuroimaging signs of cardioembolic stroke laboratory in children&#93;
| journal = [[Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova]]
| volume = 117
| issue = 3. Vyp. 2
| pages = 11–19
| year = 2017
| doi = 10.17116/jnevro20171173211-19
| pmid = 28665364
}}</ref><ref>{{Cite journal
| author = [[Sanjay Konakondla]], [[Clemens M. Schirmer]], [[Fengwu Li]], [[Xiaogun Geng]] & [[Yuchuan Ding]]
| title = New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments
| journal = [[Aging and disease]]
| volume = 8
| issue = 2
| pages = 136–148
  | year = 2017
| doi = 10.14336/AD.2016.0915
  | pmid = 28400981
}}</ref><ref>{{Cite journal
  | author = [[Priyanka Yadav]], [[Alec L. Bradley]] & [[Jonathan H. Smith]]
| title = Recognition of Chronic Migraine by Medicine Trainees: A Cross-Sectional Survey
| journal = [[Headache]]
| year = 2017
| doi = 10.1111/head.13133
| pmid = 28653369
}}</ref><ref>{{Cite journal
| author = [[S. Wulffeld]], [[L. S. Rasmussen]], [[B. Hojlund Bech]] & [[J. Steinmetz]]
| title = The effect of CT scanners in the trauma room - an observational study
| journal = [[Acta anaesthesiologica Scandinavica]]
| volume = 61
| issue = 7
| pages = 832–840
| year = 2017
  | doi = 10.1111/aas.12927
| pmid = 28635146
}}</ref><ref>{{cite journal |vauthors=Johnston PC, Chew LS, Hamrahian AH, Kennedy L |title=Lymphocytic infundibulo-neurohypophysitis: a clinical overview |journal=Endocrine |volume=50 |issue=3 |pages=531–6 |year=2015 |pmid=26219407 |doi=10.1007/s12020-015-0707-6 |url=}}</ref><ref>{{cite journal |vauthors=Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S |title=Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours |journal=Nat Rev Neurol |volume=13 |issue=1 |pages=52–64 |year=2017 |pmid=27982041 |doi=10.1038/nrneurol.2016.185 |url=}}</ref><ref name="pmid9541295">{{cite journal| author=Sato N, Sze G, Endo K| title=Hypophysitis: endocrinologic and dynamic MR findings. | journal=AJNR Am J Neuroradiol | year= 1998 | volume= 19 | issue= 3 | pages= 439-44 | pmid=9541295 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9541295  }} </ref>


{| class="wikitable"
! rowspan="3" |Disease
! colspan="3" |Symptoms
! rowspan="3" |Gold Standard
! rowspan="3" |CT/MRI
! rowspan="3" |Other Investigation Findings
|-
! colspan="2" |'''Headache'''
! rowspan="2" |Other features
|-
!Onset
!Characteristics
|-
|Pituitary apoplexy
|Sudden
|Severe [[headache]]
|
* [[Nausea and vomiting]]
* Paralysis of eye muscles ([[diplopia]])
* Changes in vision
|MRI
|
* [[CT]] scan without [[Contrast medium|contrast]] is the initial test of choice. Pituitary hemorrhage on [[CT]] presents as a hyper-dense lesion.
* [[MRI]] is done in cases of inconclusive [[CT]]. An [[MRI]] is more sensitive in identifying [[intrasellar]] mass and soft tissue changes.
|[[Blood tests]] may be done to check:
* PT/INR and aPTT
* Pituitary hormonal assay
|-
|[[Subarachnoid hemorrhage]]
|Sudden
|
* [[Headache|Severe headache]]
* <nowiki/>[[Thunderclap headache|Thunderclap]]
* Described as the worst headache of life
|
* [[Double vision]]
* [[Nausea]] and [[vomiting]]
* Symptoms of [[meningeal irritation]]
* Sudden [[Loss of consciousness|decreased level of consciousness]]
|[[Digital subtraction angiography]]
|
* The modality of choice for diagnosis of [[subarachnoid hemorrhage]] is noncontrast head [[Computed tomography|computed tomography (CT)]], with or without [[lumbar puncture]].<sup>[[Subarachnoid hemorrhage CT#cite note-pmid7897421-1|[1]]]</sup>
* [[Computed tomography|CT]] shows hyperattenuating material filling the subarachnoid space.
|
* [[Lumbar puncture|Lumbar puncture (LP)]] is necessary when there is a strong suspicion of [[subarachnoid hemorrhage]]. LP will show:
** Elevated opening pressure
** Elevated [[Red blood cell|red blood cell (RBC)]]
** [[Xanthochromic|Xanthochromia]]
|-
|[[Meningitis]]
|Sudden
|[[Headache]] is associated with:
* [[Fever]]
* [[Neck stiffness]]
|
* [[Photophobia]]   
* [[Phonophobia]] 
* [[Irritability]]
* [[Altered mental status]]
|[[Lumbar puncture]] for [[CSF]]
|
* [[CT]] scan of the head may be performed before [[Lumbar puncture|LP]] to determine the risk of [[herniation]].
|
* Diagnosis is based on clinical presentation in combination with [[CSF]] analysis.
* [[CSF]] analysis is the investigation of choice.
* For more information on [[CSF]] analysis in meningitis please [[Meningitis#Diagnosis|click here.]]
|-
|[[Intracranial mass]]
|Gradual
|[[Morning headache]]
|
* [[Nausea]]
* [[Vomiting]]
* [[Change in mental status]]
* [[Seizures]]
* Focal neurological deficits
|[[MRI]]
|
* [[CT]] or [[MRI]] is the initial test to detect intracranial lesions (ring enhancing lesions).
* These imaging tests determine the location of [[intracranial mass]] lesion(s) and help in guiding [[therapy]].
|
* [[Biopsy]] of the lesion may be done to identify the nature of the lesion such as:
** [[Tumor]]
** [[Abscess]]
* X-ray of the skull is a non specific test, but useful if any of the lesions are [[Calcified lesion|calcified]]
|-
|[[Cerebral hemorrhage]]
|Sudden
|Rapidly progressing headache
|
* Symptoms of [[increased intracranial pressure]] (ICP)
* Focal neurological deficits
|[[CT]] without [[Contrast medium|contrast]]
(differentiate [[ischemic stroke]] from [[hemorrhagic stroke|hemorrhagic stroke]])
|
* [[CT]] is very sensitive for identifying acute [[hemorrhage]] which appears as a hyperattenuating clot.
* Gradient echo and T2 susceptibility-weighted [[MRI]] are as sensitive as [[CT]] for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage.
|
* [[PT]]/[[INR]] and [[aPTT]] should be checked to rule out [[coagulopathy]].
|-
|[[Intracranial venous thrombosis]]
|Gradual
|
* Diffuse [[headache]]
* [[Headache]] can be the only symptom of [[Cerebral venous sinus thrombosis|cerebral venous thrombosis]]
|
* Focal neurological deficits
* [[Seizure|Seizures]]
* [[Coma|Depressed level of consciousness]] 
|[[Digital subtraction angiography]]
|
* The classic finding of sinus thrombosis on unenhanced [[CT]] images is a hyperattenuating thrombus in the occluded sinus.
* [[CT]] and [[MRI]] may identify [[Cerebral edema]] and venous [[infarction]] may be apparent.
|
* CT [[venography]] detects the [[thrombus]], [[computed tomography]] with [[radiocontrast]] in the venous phase (CT venography or CTV) has a detection rate that in some regards exceeds that of [[MRI]].
* [[Cerebral angiography]] may demonstrate smaller clots, and obstructed veins may give the "corkscrew appearance."
|-
|[[Migraine]]
|Sudden
|
* Severe to moderate [[headache]]
* One-sided
* Pulsating
* Lasts between several hours to three days.
|
* [[Nausea and vomiting]]
* Preceding [[Aura (symptom)|aura]]
* [[Photophobia]]
* [[Phonophobia]]
|'''---'''
|
* [[CT]] and [[MRI]] may be needed to rule out other suspected possible causes of [[headache]].
|
* [[Migraine]] is a clinical [[diagnosis]] that does not require any laboratory tests.
* Laboratory tests may be ordered to rule out any suspected coexistent metabolic problems.
|-
|[[Head injury]]
|Sudden
|
* Dull
* Throbbing
* One sided or all around
|
* [[Confusion]]
* [[Drowsiness]]
* Personality change
* [[Seizure|Seizures]]
* [[Nausea]] and [[vomiting]]
* [[Headache|Loss of consciousness]]
* [[Lucid interval]]
|[[CT]] scan without contrast
|
* [[CT]] scan is the first test performed and identifies [[cerebral hemorrhage]] (appears as a hyperattenuating clot) following head injury.
* [[MRI]] is more sensitive, takes more time, and is done in patients with symptoms unexplained by [[Computed tomography|CT]] scan.
|
* The [[Glasgow Coma Scale]] is a tool for measuring degree of unconsciousness and is a useful tool for determining severity of injury.
* The [[Pediatric Glasgow Coma Scale]] is used in young children.
|-
|[[Lymphocytic hypophysitis]]
|Sudden
|
* Generalized
* Retro-orbital or Bitemporal
|
* Most often seen in late pregnancy or the [[postpartum]] period
* Mass lesion effect such as [[Visual field defect|visual field defects]]
* [[Hypopituitarism]]
|Pituitary biopsy
|[[CT]] & [[MRI]] typically reveal features of a pituitary mass.
|The most accurate test is a pituitary [[biopsy]] which will show [[lymphocytic]] [[Infiltration (medical)|infiltration]].
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{reflist|2}}
[[Category:Needs content]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Dermatology]]
[[Category:Endocrinology]]
[[Category:Cardiology]]
[[Category:Neurology]]
[[Category:Radiology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Needs content]]


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Latest revision as of 20:03, 2 August 2017

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Differentiating Radiation injury From Other Diseases

Radiation injury should be differentiated from other diseases causing severe headache for example: [1][2][3][4][5][6][7][8][9][10]

Disease Symptoms Gold Standard CT/MRI Other Investigation Findings
Headache Other features
Onset Characteristics
Pituitary apoplexy Sudden Severe headache MRI
  • CT scan without contrast is the initial test of choice. Pituitary hemorrhage on CT presents as a hyper-dense lesion.
  • MRI is done in cases of inconclusive CT. An MRI is more sensitive in identifying intrasellar mass and soft tissue changes.
 Blood tests may be done to check:
  • PT/INR and aPTT
  • Pituitary hormonal assay
Subarachnoid hemorrhage Sudden Digital subtraction angiography
Meningitis Sudden Headache is associated with: Lumbar puncture for CSF
  • CT scan of the head may be performed before LP to determine the risk of herniation.
  • Diagnosis is based on clinical presentation in combination with CSF analysis.
  • CSF analysis is the investigation of choice.
  • For more information on CSF analysis in meningitis please click here.
Intracranial mass Gradual Morning headache MRI
  • CT or MRI is the initial test to detect intracranial lesions (ring enhancing lesions).
  • These imaging tests determine the location of intracranial mass lesion(s) and help in guiding therapy.
  • Biopsy of the lesion may be done to identify the nature of the lesion such as:
  • X-ray of the skull is a non specific test, but useful if any of the lesions are calcified
Cerebral hemorrhage Sudden Rapidly progressing headache
  • Focal neurological deficits
 CT without contrast

(differentiate ischemic stroke from hemorrhagic stroke)

  • CT is very sensitive for identifying acute hemorrhage which appears as a hyperattenuating clot.
  • Gradient echo and T2 susceptibility-weighted MRI are as sensitive as CT for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage.
Intracranial venous thrombosis Gradual Digital subtraction angiography
  • The classic finding of sinus thrombosis on unenhanced CT images is a hyperattenuating thrombus in the occluded sinus.
  • Cerebral angiography may demonstrate smaller clots, and obstructed veins may give the "corkscrew appearance."
Migraine Sudden
  • Severe to moderate headache
  • One-sided
  • Pulsating
  • Lasts between several hours to three days.
 ---
  • CT and MRI may be needed to rule out other suspected possible causes of headache.
  • Migraine is a clinical diagnosis that does not require any laboratory tests.
  • Laboratory tests may be ordered to rule out any suspected coexistent metabolic problems.
Head injury Sudden
  • Dull
  • Throbbing
  • One sided or all around
 CT scan without contrast
  • CT scan is the first test performed and identifies cerebral hemorrhage (appears as a hyperattenuating clot) following head injury.
  • MRI is more sensitive, takes more time, and is done in patients with symptoms unexplained by CT scan.
Lymphocytic hypophysitis Sudden
  • Generalized
  • Retro-orbital or Bitemporal
  • Most often seen in late pregnancy or the postpartum period
 Pituitary biopsy CT & MRI typically reveal features of a pituitary mass. The most accurate test is a pituitary biopsy which will show lymphocytic infiltration.

References

  1. ↑ Endrit Ziu & Fassil Mesfin (2017). "Subarachnoid Hemorrhage". PMID 28722987.
  2. ↑ Benedikt Schwermer, Daniel Eschle & Constantine Bloch-Infanger (2017). "[Fever and Headache after a Vacation in Thailand]". Deutsche medizinische Wochenschrift (1946). 142 (14): 1063–1066. doi:10.1055/s-0043-106282. PMID 28728201.
  3. ↑ Otto Rapalino & Mark E. Mullins (2017). "Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies". Neurosurgery. doi:10.1093/neuros/nyx201. PMID 28575459.
  4. ↑ I. B. Komarova, V. P. Zykov, L. V. Ushakova, E. K. Nazarova, E. B. Novikova, O. V. Shuleshko & M. G. Samigulina (2017). "[Clinical and neuroimaging signs of cardioembolic stroke laboratory in children]". Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 117 (3. Vyp. 2): 11–19. doi:10.17116/jnevro20171173211-19. PMID 28665364.
  5. ↑ Sanjay Konakondla, Clemens M. Schirmer, Fengwu Li, Xiaogun Geng & Yuchuan Ding (2017). "New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments". Aging and disease. 8 (2): 136–148. doi:10.14336/AD.2016.0915. PMID 28400981.
  6. ↑ Priyanka Yadav, Alec L. Bradley & Jonathan H. Smith (2017). "Recognition of Chronic Migraine by Medicine Trainees: A Cross-Sectional Survey". Headache. doi:10.1111/head.13133. PMID 28653369.
  7. ↑ S. Wulffeld, L. S. Rasmussen, B. Hojlund Bech & J. Steinmetz (2017). "The effect of CT scanners in the trauma room - an observational study". Acta anaesthesiologica Scandinavica. 61 (7): 832–840. doi:10.1111/aas.12927. PMID 28635146.
  8. ↑ Johnston PC, Chew LS, Hamrahian AH, Kennedy L (2015). "Lymphocytic infundibulo-neurohypophysitis: a clinical overview". Endocrine. 50 (3): 531–6. doi:10.1007/s12020-015-0707-6. PMID 26219407.
  9. ↑ Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S (2017). "Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours". Nat Rev Neurol. 13 (1): 52–64. doi:10.1038/nrneurol.2016.185. PMID 27982041.
  10. ↑ Sato N, Sze G, Endo K (1998). "Hypophysitis: endocrinologic and dynamic MR findings". AJNR Am J Neuroradiol. 19 (3): 439–44. PMID 9541295.

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