Does this brain scan need to be repeated due to incomplete visualization of certain areas?

Brain CT Scan Needs to Be Repeated Due to Incomplete Visualization

Yes, this brain CT scan needs to be repeated because parts of the inferior cerebellum, brainstem, and intracranial cavity were not included, which could miss critical pathology that impacts patient morbidity and mortality.

Rationale for Repeating the Scan

• CT scan is the first-line imaging modality for evaluation of acute head trauma, and complete visualization of all intracranial structures is essential for accurate diagnosis 1
• The current scan has significant limitations with parts of the inferior cerebellum, brainstem, and intracranial cavity not included, making it impossible to evaluate these areas for potential pathology 1
• Helical CT with sections constructed with thickness of more than one millimeter is the reference method in traumatic brain injury, and all sections should be properly visualized 1

Clinical Importance of Complete Brain Imaging

• The brainstem contains critical structures that control vital functions, and pathology in this area can have significant impacts on morbidity and mortality 2
• Posterior fossa structures (cerebellum, brainstem) can harbor significant pathology that may not be clinically apparent but could require urgent intervention 1
• Missing pathology in these areas could lead to delayed diagnosis of potentially life-threatening conditions such as:
  • Intracranial hemorrhage that could require neurosurgical intervention 1
  • Brainstem infarcts or contusions that may not be evident on clinical examination 3
  • Mass lesions that could lead to herniation or increased intracranial pressure 1

Addressing the Facial Fractures

• The scan identified comminuted fracture of the bony external nose and probable blowout fracture of the medial wall of right orbit 1
• While these findings are important, they should be addressed with dedicated maxillofacial CT as recommended in the report, separate from the need to complete the brain imaging 1
• Facial fractures, particularly those involving the skull base, can be associated with intracranial injuries that may not be fully evaluated on the incomplete scan 1

Recommended Approach

• Complete the brain CT scan as soon as possible to evaluate the missing areas (inferior cerebellum, brainstem, and lower intracranial cavity) 1
• This is particularly important given that the radiologist specifically noted these areas could not be evaluated and recommended additional scanning 1
• The additional radiation exposure from completing the scan is relatively small compared to the risk of missing potentially serious pathology 1
• The time required for completing a head CT scan is minimal (approximately 11-12 minutes) compared to the potential benefit of identifying critical pathology 1

Potential Pitfalls to Avoid

• Do not assume that normal findings in visualized areas mean that non-visualized areas are also normal 1
• Do not delay repeat imaging if clinically indicated, as early detection of intracranial pathology is crucial for optimal outcomes 1
• Do not rely solely on clinical examination to rule out pathology in non-visualized areas, as some brainstem and cerebellar lesions may present with subtle or delayed symptoms 3
• Avoid the assumption that facial fractures are the only significant findings, as they may coexist with more serious intracranial injuries 1