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16 yrs CT scan of brain showed mild prominence of cortical sulci in both cerebral hemisphere. Meaning?

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My daughter 16 yrs CT scan brain plain was done and the report says mild prominence of cortical sulci in both cerebral hemisphere
She complains of headache when studying after 20 mins
Posted Sun, 4 Aug 2013 in Brain and Spine
Answered by Dr. Taher Kagalwala 2 hours later

For a young woman of 16, headaches can be due to many causes. It appears that you have already taken her to general practitioners and perhaps even a physician. Sometimes, headaches can be due to stress or errors of sight. Tension headache is one such stress headache that tends to occur due to the stress of studies. Sight errors usually cause headaches after some time of using the eyes to see close objects, such as while studying from a book.

I do not know the background behind the child's headaches. Perhaps you could supply me more details like:
- since when the headaches have started,
- has she any other symptoms like vomiting, nervousness, overeating or under-eating,
- association of headache with any peculiar symptoms like, for example, headache occurs on specific days or at specific timings, etc.,
- what tests were done before going in for the CT scan, and what were the results thereof, and
- what treatment does she take when the headache occurs and does it help, and if it does help, how long does it take to get relief.

Please also let me know if you or her sisters or any other family members have the same problem as her, may it be less or more.

I strongly suggest that you revert to me within the next 24 hours. I will be keenly awaiting the replies to my questions.

Thank you for addressing your query on WWW.WWWW.WW

With regards and best wishes for a speedy recovery of your daughter,

= Dr. Taher
Above answer was peer-reviewed by
Follow-up: 16 yrs CT scan of brain showed mild prominence of cortical sulci in both cerebral hemisphere. Meaning? 19 hours later
She has this complaint since last 2 months.
she has a symptom of overeating and nevousness.
headache happens every now and then
only Xray was done where it was reported sinusitis first and advised Left Lateral Xray there the report was raised intracranial tension and pituitary fossa deepened and suggested CT scan.
The neuro phsycian Dr K K XXXXXXX MD FRCP after seeing the CT scan where it was reported mild prominence of cortical sulci in both cerebral hemisphere has advised Amitriptaline 10mg and stemetil 5mg twice daily. We have not started the medicine yet but he had given clocit 5mg earlier and after having one tablet she felt drowsy the next whole day but no headache
There is no such family history but I her father was on fludac and Trika 1998 to 2003, now I do not take these medicine.
Please advice.
Answered by Dr. Taher Kagalwala 3 hours later

Thank you for your clarifications and replies. Looking at the details of the X rays, CT scan etc, and the history, I am inclined to believe that your daughter could be either suffering from migraine or stress headaches. I am rather surprised that the radiologist opined on raised intracranial pressure only on the basis of an X XXXXXXX If there is something else to be done, it would be a MRI. This is the only investigation that can tell the doctors about the exact problem inside your daughter's brain.

There is an entity known as Benign Intracranial Hypertension (BIT) (also called Idiopathic Intracranial Hypertension). This occurs in adolescents and has no known cause. Children with this problem actually have a raised pressure inside the brain, and the commonest symptom of this is headaches. If this is suspected on the MRI, it can be proved by the pediatric neurologist on doing a small puncture on her back and removing what is known as the cerebro-spinal fluid (CSF). This fluid normally circulates around the spinal cord and the brain at a "normal" pressure. In children with BIT, the CSF comes out at a very high pressure, and typically, after this procedure, the child has a great relief of the headaches. Unfortunately, some children may need repeated removal of CSF at intervals of every 15-30 days, in addition to drugs that reduce the raised pressure.

BIT and migraine are real possibilities, but it seems that anxiety/depression or stress has been suspected by her doctor in view of the prescription of amitryptiline.

You should -
a) get a MRI done
b) check her vision with an eye specialist
c) get the sinuses evaluated by an ENT doctor
d) get her examined by a psychiatrist

I know this sounds like a long and expensive list. However, there is a genuine problem here. Perhaps the best thing for you would be to access a good pediatrician near your home (I believe you live near Gurgaon), but within a large hospital, so that multi-consultations and diagnosis becomes easier. I suggest that you seek help in one of the corporate hospitals. As an alternative, you could consult "Headache specialists" who can coordinate the other disciplines correctly.

In the end, the speed of evaluation would depend on the severity of her symptoms, the ability by you to spend your hard-earned money and the speed with which the medical team approaches the whole problem.

I hope to interact further with you as needed by you. My profile lists my contact on social platforms too. You may continue consulting with me even after this questions' duration and privileges expire.

With best wishes,

Dr. Taher
Above answer was peer-reviewed by
Follow-up: 16 yrs CT scan of brain showed mild prominence of cortical sulci in both cerebral hemisphere. Meaning? 34 hours later
Dear Doctor

Thanks for your advice, but the headache is episodic and last for few minutes only and after that its OK. The heaviness is always there but she is absolutely normal otherwise.

If you insist we can get the MRI done but the Neuro Physician we have consulted has 40 years of experience and also know to us very well. He has not advised for the same, and we are apprehensive for the additional radiation due to the MRI.

Can you not suggest any additional medicine which could help us diagnose the problem further, in case the same is required.

However we live in Ranchi (Jharkhand), please suggest anything here in case the problem as per you is not that severe that we have to go to higher medical center for further consultation.
Answered by Dr. Taher Kagalwala 11 hours later

Sorry for the delay in the reply. After reading your clarifications, I think we could hold the MRI. In any case, there is no exposure to radiation with MRI as there are no Xrays in this investigation. Please do get the other tests and consultations done, though. It is heartening that the headaches are brief, and this therefore might mean that they are stress headaches and nothing more serious. However, do get an eye specialist and a psychologist take a look at her. In the meantime, pending a diagnosis, I would only recommend paracetamol or ibuprofen tablets for pain relief.

With best wishes,

Dr Taher

P.S. Do contact me again either through XXXXXXX or through my social presence on Facebook.
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