What tests should be done on the head during a routine physical examination?

There are actually not many default items for routine physical examinations. Most of them are basic screening tests at the general screening level. Only people with high-risk factors need additional more precise examination items.

A while ago, I helped my elderly family members choose a physical examination package. I looked through the basic files of seven or eight public physical examination centers and private institutions, and found that the default head-related items basically fall into two categories: one is the basic physical examination of neurology, and the other is transcranial Doppler, which is commonly known as TCD.

Don’t think that doctors are fooling people by asking casual questions and hitting them twice with a hammer. Last year, a young man in my department didn’t feel any discomfort at all. During the physical examination, the doctor asked him to rotate his hands and point his nose, but he couldn’t point correctly several times. The doctor suggested him to do a CT scan on the spot. In the end, it was found that it was a small lacunar cerebral infarction. Because it was discovered early, he could adjust his work schedule and take some medicine. If he had waited until symptoms of numbness appeared in the limbs to check, it would have been delayed. Many physical examination packages also include fundus examinations in head-related items. After all, the fundus is the only blood vessel that can be directly observed with the naked eye. Checking whether the fundus arteries are hardened can also indirectly reflect the status of the cerebral blood vessels.

Another common TCD is even simpler. Apply some cool coupling agent and stick the probe at the temples and behind the ears for ten minutes to measure the speed of cerebral blood flow and check for vasospasm and insufficient blood supply to the brain. It is especially suitable for young people who often stay up late and get migraines at every turn. It also has no radiation and costs about 100 yuan, so it is very cost-effective. However, there are different opinions in the industry about this project. Some doctors feel that the TCD results rely too much on the experience of the operating technician, and the error is not small. It is better to directly perform cervical vascular ultrasound to evaluate the blood supply to the brain. However, it is cheap and non-invasive, and routine screening is still enough.

If you have basic diseases such as high blood pressure, diabetes, or hyperlipidemia, or have a long-term habit of smoking and drinking, or you often have inexplicable dizziness or headaches, or even have a history of head trauma, then the default items will definitely not be enough and you will have to add items yourself. My distant uncle has a history of high blood pressure for more than 20 years and has been a smoker for almost 30 years. A low-dose head CT scan must be included in his annual physical examination. The year before last, a very small intracranial aneurysm was detected as part of the routine examination. He underwent embolization surgery in time, and he saved his life before it ruptured and caused an accident. However, I should also mention here that healthy young people should not listen to the scams sold by medical examination institutions and just add head CT scans. After all, there is radiation. The amount of radiation taken once a year is much higher than that of ordinary chest X-rays. If you don’t have high-risk factors, there is no need to suffer this sin.

If there are any doubts found on CT, the doctor will generally recommend further MRI of the head, which does not involve radiation and can see the soft tissues much more clearly than CT. However, it is more expensive, usually more than a thousand times, and requires lying in a confined space for 20 minutes without moving. People with claustrophobia will most likely not be able to bear it, and few people will directly add it to the routine physical examination.

To be honest, the more expensive the physical examination items are, the better, nor does it mean that the more you add, the more peace of mind you will have. If you don’t have any head discomfort or underlying diseases, the regular basic items are completely enough. If you really have persistent dizziness, headaches, and numbness in your hands and feet, go directly to the hospital to register, which is much more reliable than buying a high-priced physical examination package.