By Charlotte Kerner; Elizabeth D Crawford

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Acute visual changes could relate to rapid pituitary enlargement in the cases of apoplexy while embolic phenomena can occur in the setting of carotid dissection or cardiac abnormalities such as atrial fibrillation. Cranial nerves III, IV, V, and VI Anatomically, cranial nerve III originates anteriorly from the midbrain, IV from the dorsal midbrain and courses anteriorly, V from the anterolateral pons, and VI from the anterior pontomedullary junction, and all may be affected by lesions in these regions.

Reproduced from Reference 2 with permission of Elsevier. angiography. Nonaneurysmal SAH is typically induced by hypertension and may relate to failure of intracranial autoregulation and rupture of the relatively thin-walled pial veins [78]. A spinal MR may be attempted and repeat cerebral catheter angiography may be considered if initial examinations fail to identify an underlying cause. Intra-axial hemorrhage Hemorrhagic infarction Despite the physiologic changes associated with pregnancy, multicenter randomized trials have not shown an increased risk of ischemic or hemorrhagic infarction during pregnancy.

In these cases, an MRI of the brain should be considered. 4 Preferred imaging modality in evaluating suspected underlying cause of headache MRI preferred Vascular disease: cerebral infarction and venous infarct Neoplasm: primary and metastatic tumors, skull base tumors, carcinomatosis, and pituitary tumors Infections: cerebritis, brain abscess, encephalitis, and meningitis Chiari malformations Intracranial hypotension/CSF leaks Pituitary apoplexy Rare encephalopathies: CADASIL, MELAS, and SMART CT preferred Fractures Trauma Acute hemorrhage: subarachnoid, intraparenchymal, epidural, and subdural Sinus and mastoid disease MRI and CT equivalent MR/CT arteriography: vasculitis, aneurysms, carotid, and vertebral dissection MR/CT venography: cerebral venous thrombosis Reproduced from Reference 71 with permission of Mayo Foundation for Medical Education and Research.

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