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To the Editor.—
The article by Larson et al discourages the use of CT head scanning in examination of patients with headache and normal neurological examinations. Their article implies that their patients were screened by neurological specialists and that normal findings from neurological examination in their hands are almost always associated with a normal CT scan.As a neurosurgeon to whom patients are referred largely by primary care physicians, I deal with the converse problem. Almost every week I see patients whose headaches have been attributed to sinus, hypertension, and various other causes, because the findings from the neurological examination were said to be normal. Ultimate diagnoses in the last few patients have included frontal meningioma, temporal lobe glioblastoma, intraventricular hemorrhage from aneurysm, cerebellar astrocytoma with hydrocephalus, adult aqueductal stenosis with hydrocephalus, and, of course, subdural hematoma. Most of these patients are referred to me not for headache, but only
Bohmfalk GL. Computerized Tomographic Scans for Headache. JAMA. 1980;244(2):133. doi:10.1001/jama.1980.03310020015008