Monday 7 October 2013

Appropriate initial imaging studies in Neuro as per clinical problems

                      Clinical problem                                             Modality
Fractures / Bony lesions of Skull
CT brain with bone window
Major head trauma
CT (neurologically unstable); MRI (neurologically stable)
Mild head trauma
Observe; CT (if persistent headache)
Acute hemorrhage (Bleed)
Non contrast CT
Suspected intracerebral aneurysm or AV Malformations
MRI Brain with (3D TOF Non Contrast) MR Angiography 
Non contrast CT < MRI
Transient Ischemic Attack
Non contrast CT, MRI if vertebro basilar findings; consider carotid Doppler if bruit present. 
Recent giddiness and walking imbalance
MRI Brain with 3D TOF Non Contrast MR Angiography 
Acute stroke (suspected hemorrhagic)
Noncontrast CT
Acute stroke (suspected non hemorrhagic)
MRI Brain with (3D TOF Non Contrast) MR Angiography 
Multiple sclerosis
MRI Brain and Whole Spine screening for Cord
Tumor or metastases
MRI with Contrast 
Aneurysm (chronic history)
3D TOF Non Contrast MR Angiography or Contrast CT Angiography
Contrast CT / MRI
Preoperative for cranial surgery
Contrast angiography
Lumbar tap; CT Brain only to exclude complications
Seizure (new onset or poor therapeutic response)
MRI (Epilepsy protocol)
Seizure (febrile or alcohol withdrawal without neurologic deficit)
CT / MRI sos
Neurologic deficit with known primary tumor elsewhere
MRI if associated sensorineural findings
Vertigo (if suspect acoustic neuroma or posterior fossa tumor)
MRI with thin sections for Cranial Nerve imaging
CT Brain covering Para nasal sinuses 
Nothing, or MRI Brain 
Alzheimer’s disease
Nuclear medicine SPECT scan
CT / MRI Brain with limited axial sections to cover sinuses

Reference: Mettler, Essentials of Radiology, 2nd ed.

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