What to do on the head during a routine physical examination

There are no unified mandatory imaging items for head examinations in routine physical examinations. Most basic packages only include physical examinations from neurology or surgery. Only people with high-risk factors are recommended to do additional targeted screening items.

I was struggling with this when I accompanied my mother to choose the annual physical examination package two months ago. At that time, I looked at the list of additional items including head CT, head MRI, and transcranial Doppler. I almost got excited and added them all, but the medical examiner who attended the consultation stopped me. I said that my mother didn’t have any underlying diseases except for a little bit of essential hypertension. She didn’t suffer from headaches, dizziness, or numbness in her hands and feet. She just had to do a basic physical examination first. If she was really worried, a transcranial Doppler to check the blood supply to the brain would be enough. She didn’t need to do a CT scan with radiation.

Don’t think that the doctor is just trying to stop you by asking you to close your eyes and point to your nose, turn your eyelids to look at your pupils, touch the carotid arteries on your neck, and ask if you have forgotten anything recently or if you have a headache. These simple operations are the most basic means of screening for head problems. Many early signs of insufficient blood supply to the brain, facial nerve abnormalities, and even signs of cognitive decline are discovered first through these small examinations, which are much more cost-effective than taking X-rays.

As for the most discussed question now, "Should we proactively add head CT to routine physical examinations?", there are actually different opinions in the industry. Those who support it believe that the radiation dose of low-dose head CT is not as large as the cosmic radiation received by taking a long-distance flight. Doing it once a year can detect unruptured aneurysms, lacunar infarcts and even early intracranial tumors early. Cancer is equivalent to an early warning insurance for cerebral blood vessels; the opposing side believes that radiation has a cumulative effect after all. For ordinary people under 35 years old, without three highs, no history of head trauma, and no family history of cerebrovascular or intracranial tumors, the probability of abnormality being detected by CT is extremely low, and the benefits are far lower than the possible risks. There is no need to spend this money and receive radiation for nothing.

I have a friend who works in Internet operations. He stays up late all the time and suffers from migraines. Last year, he took the initiative to undergo a non-radiation head MRI during his physical examination. A congenital arachnoid cyst a few millimeters in size was found. The doctor said that it would be fine without treatment and regular review. Instead, he was relieved of the worry that he had been worried about for several years. Before, he always thought that his headaches were caused by tumors. In fact, to put it bluntly, if you are a high-risk group who often have headaches, have underlying chronic diseases, or have a family history of cerebral infarction or brain tumor, no matter your age, adding an MRI or CT is not an excessive examination. If you are a young person who does not feel uncomfortable, you really can’t follow the trend.

Of course, if the doctor finds any abnormalities during the basic physical examination, such as the finger and nose are always misaligned, the sudden forgetfulness of things, or the temporary blackening of the eyes, dizziness and unsteadiness, then regardless of whether it is included in the package, you must take the initiative to tell the doctor to do the corresponding examination, and do not take it seriously.