<< An Evidence-Based Approach To Imaging Of Acute Neurological Conditions

Key Points For Imaging Of Acute Neurological Conditions

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Key Points For Imaging Of Acute Neurological Conditions

Key Points For Imaging Of Acute Neurological Conditions

1. For stroke, CT is sensitive for ruling out hemorrhage.

MRI may be even better for chronic hemorrhage.

2. For cervical artery dissections, CTA and MRA have similar high sensitivity and specificity.

3. Following an episode of syncope, head CT is not routinely indicated unless head trauma is suspected.

The diagnostic yield of CT for syncope appears to be less than 1%.

4. A negative non-contrast head CT is not widely accepted to rule out subarachnoid hemorrhage without lumbar puncture.

Although CT appears to be very sensitive, it is thought to become less sensitive with elapsed time since symptom onset, and the decline in sensitivity is not fully understood for new generation scanners.

5. Extensive early ischemic changes, especially those in an area greater than one-third of the middle cerebral artery territory, are a contraindication to TPA administration.

The radiologist should be specifically queried about these, not just for the presence or absence of hemorrhage.

6. For patients presenting with apparent TIA, the risk of progression to stroke is high.

Some have advocated admission, while others have recommended rapid outpatient evaluation. The modifiable structural risk factors for stroke include carotid stenosis and cardiac defects. One imaging strategy from the emergency department is imaging of the carotids (by CTA, ultrasound, or MRA), and echocardiography to evaluate cardiac causes of stroke.

7. Neuroimaging is not indicated for simple febrile seizures or a single occurrence of the typical seizure of a patient with prior seizure disorder.

Imaging findings relevant to management are unlikely in this setting.

8. Following blunt traumatic head injury, loss of consciousness alone is not an indication for head CT.

Clinical decision rules exist for selecting patients to forgo CT following closed head injury.

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