PO-03 | Intracranial incidental findings on brain magnetic resonance imaging (MRI) in a pediatric population with primary headache: our experience and management

Fabiana Ursitti,¹ Filippo Tripodi,¹ Laura Papetti,¹ Giorgia Sforza,¹ Gabriele Monte,¹ Alessandro Borrelli,¹ Samuela Tarantino,¹ Martina Proietti Checchi,¹ Massimiliano Valeriani^1-3 | ¹Developmental Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy; ²Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy; ³Translational Pain Neuroscience and Precision Medicine, CNAP, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark

Background: Headache is a frequent symptom in children, which often leads to the execution of neuroradiological examinations and to finding of incidentalomas. In fact, headache is often attributed to primary headache, neurological disorder common in the developmental age. Recent widespread access to neuroradiological examinations has led to a consequent increase in the number of incidental brain lesions in children with headache.

Methods: We conducted a retrospective study including 28 patients under 18 years with primary headache and incidental findings of suspected low-grade lesion at brain MRI. Data were collected on age, sex, headache characteristics. Neurological and fundus oculi evaluation were normal. All patients were treated conservatively with neuroimaging surveillance of suspected low-grade lesion. All lesions detected were defined as hyperintense in T2/FLAIR sequences, negative DWI, no increase, surrounding edema and mass effect. The lesions were divided into supratentorial (thalamic) and infratentorial (cerebellar). The first follow-up MRI was performed after 6 months and follow-ups were carried out every 12 to 18 months.

Results: Patients included 13 females (46%) and 15 males (54%): 67.8% presented migraine without aura, 25% tensive headache, 14.3% migraine with aura, 7% both tensive headache and migraine without aura. Average frequency of attacks was 2.9 attack/month. Regarding intensity of attacks: 32% presented slight attack, 57% moderate and 11% had severe attacks. Average follow-up period was 43.7 months. In following period: 7% was stable at 84 months, 17.8% at 72 months, 21.5% at 60 months, 46.5% at 48 months, 64.3% at 36 months, 96.5% at 24 months. 96.5% of the patients showed radiological stability during the whole follow-up period. No significant radiological changes were found during follow-up in 27 of 28 patients.

Conclusion: With the increasing detail of imaging techniques and their execution, there has been an increase in number of incidentally brain lesions in children with primary headache, leading to a management dilemma for pediatric neurologists. The incidentally low-grade lesions are not related to headache. This study reports data on long-term clinical and radiological follow-up period in patients with primary headache and occasional low-grade lesion findings during headache assessment, showing the stability over time and safety of conservative management.