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Evaluation of Headache-Reply

Donald L. Myers, MD
JAMA. 1981;246(18):2031-2032. doi:10.1001/jama.1981.03320180023016.
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In Reply.—  Computed axial tomography has proved to be a powerful tool in the noninvasive neurodiagnostic evaluation because of the superb diagnostic accuracy and minimal patient risk involved. Consequently, the CT scanner is inherently subject to excessive use. The advisability of restricting CT scanning in patients with headache to those having abnormalities in their neurological examination has been discussed as a means for lessening the economic burden.Drs Ordia and Mark have posed several circumstances under which potentially hazardous intracranial lesions may be present without notable neurological abnormality on examination. Their comments are entirely appropriate and describe problems encountered in active clinical practice. Midline posterior fossa lesions causing hydrocephalus from fourth ventricular outflow obstruction, pinealomas, and giant aneurysms are other entities that may be present without obvious neurological signs. CT scanning may obviate the need for lumbar puncture in a patient suspected of having subarachnoid hemorrhage by documenting the presence


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