Headache is a very common symptom that a patient presents with in the acute outpatient clinic. Repeated migraine-like headache can be misleading and lead to partial downplaying of the difficulty, but it is of course appropriate to perform an imaging examination if this has not already been done. We present here an example of a young patient who visited our outpatient clinic in similar circumstances with very surprising findings on neuroimaging, her diagnosis, treatment, and evolution over time. We demonstrate here the importance of assessing the sensitivity of individual tests and, even if the diagnostic criteria were not met, the high suspicion of a disease that is very rare in our country.

Bolest hlavy je velmi častý příznak, se kterým přijde pacient do akutní ambulance. Opakovaná bolest hlavy migrenózního charakteru může být zavádějící a vést k částečné bagatelizaci obtíží, ale je samozřejmě na místě provedení zobrazovacího vyšetření, pokud toto provedeno dosud nebylo. Uvádíme zde příklad mladé pacientky, která za obdobných okolností navštívila naši ambulanci s velmi překvapivým nálezem na zobrazovacích vyšetřeních, její diagnostiku, léčbu a vývoj v čase. Dokládáme zde důležitost posouzení senzitivity jednotlivých testů a, i když nebyla naplněna daná diagnostická kritéria, velkou suspekci na onemocnění, které se v našich krajinách vyskytuje velmi raritně.

• MeSH
• Albendazole administration & dosage   MeSH
• Headache * diagnostic imaging   etiology   drug therapy   cerebrospinal fluid   MeSH
• Diagnosis, Differential MeSH
• Adult MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Brain diagnostic imaging   pathology   MeSH
• Neurocysticercosis diagnostic imaging   drug therapy   cerebrospinal fluid   pathology   therapy   MeSH
• Treatment Failure MeSH
• Tomography, X-Ray Computed MeSH
• Sensation Disorders etiology   MeSH
• Spinal Puncture MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Headache diagnostic imaging   etiology   MeSH
• Diagnosis, Differential MeSH
• Middle Aged MeSH
• Humans MeSH
• Subarachnoid Hemorrhage * diagnostic imaging   pathology   therapy   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Acute Disease * MeSH
• Medical History Taking MeSH
• Headache diagnostic imaging   etiology   MeSH
• Stroke diagnosis   etiology   MeSH
• Diagnosis, Differential MeSH
• Mental Disorders diagnosis   nursing   therapy   MeSH
• Epilepsy complications   MeSH
• Humans MeSH
• Migraine Disorders diagnosis   therapy   MeSH
• Nervous System Diseases * diagnosis   classification   complications   therapy   MeSH
• Patient Admission MeSH
• Subarachnoid Hemorrhage diagnosis   etiology   therapy   MeSH
• Vertigo MeSH
• Vestibular Diseases classification   MeSH
• Seizures etiology   therapy   MeSH
• Dizziness diagnosis   etiology   classification   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Purpose: Transcranial B-mode sonography (TCS) of brain parenchyma is increasingly used as a diagnostic tool for movement disorders. Accordingly, experimental B-Mode Assist software was developed to enable digitized analysis of the echogenicity of predefined brain regions. The aim of the study was to assess the reproducibility of digitized TCS image analysis of the insula. Materials and Methods: A total of 130 patients with an indication for neurosonological examination were screened for participation in the study. The insula was imaged from the right temporal bone window using Virtual Navigator and TCS-MRI (magnetic resonance imaging) fusion imaging. All subjects were examined three times by two experienced sonographers. Corresponding images of the insula in the axial thalamic plane were encoded and digitally analyzed. Interclass correlation coefficient (ICC) and Spearman's rank correlation coefficient were used for the assessment of intra- and inter-reader as well as intra- and inter-investigator reliabilities. Results: TCS images of 114 patients were evaluated (21 patients with TIA, 53 patients with headache, 18 patients with essential tremor, 22 patients with neurodegerative disease). 16 patients were excluded from analysis due to insufficient bone window. The intra-reader, inter-reader, intra-investigator and inter-investigator ICCs/Spearman's rank correlation coefficients were 0.995/0.993, 0.937/0.921, 0.969/0.961 and 0.875/0.858, resp. Conclusion: The present study demonstrates a high reliability to reproduce echogenicity values of the insula using digitized image analysis and TCS-MRI fusion images with almost perfect intra-reader, inter-reader, intra-investigator and inter-investigator agreement.

• MeSH
• Headache diagnostic imaging   MeSH
• Essential Tremor diagnostic imaging   MeSH
• Image Interpretation, Computer-Assisted methods   MeSH
• Contrast Media * MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Cerebral Cortex diagnostic imaging   MeSH
• Multimodal Imaging methods   MeSH
• Neurodegenerative Diseases diagnostic imaging   MeSH
• Infant, Newborn MeSH
• Observer Variation MeSH
• Reproducibility of Results MeSH
• Statistics as Topic MeSH
• Pregnancy MeSH
• Thalamus diagnostic imaging   MeSH
• Ischemic Attack, Transient diagnostic imaging   MeSH
• Ultrasonography, Doppler, Transcranial methods   MeSH
• User-Computer Interface MeSH
• Image Enhancement methods   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH