From the Guidelines
CT brain scans are indicated for several neurological conditions and situations, including suspected traumatic brain injury, sudden severe headaches, symptoms of stroke, new-onset seizures, suspected intracranial infections, unexplained altered mental status, and evaluation of patients with persistent neurological deficits. The primary indications for CT brain scans can be broken down into several key areas:
- Suspected traumatic brain injury, especially in patients with altered mental status, loss of consciousness, or concerning neurological findings after head trauma 1
- Evaluating patients with sudden severe headaches to rule out subarachnoid hemorrhage 1
- Symptoms of stroke to determine if it's ischemic or hemorrhagic, which guides treatment decisions 1
- New-onset seizures, suspected intracranial infections like meningitis or encephalitis, unexplained altered mental status, and evaluation of patients with persistent neurological deficits 1
- Monitoring known brain tumors, hydrocephalus, or ventriculoperitoneal shunt function, and evaluating patients with suspected increased intracranial pressure 1
Some key points to consider when deciding to use CT brain scans include:
- CT is preferred in emergency situations because it's quick, widely available, and effectively detects acute hemorrhage, large infarcts, mass effect, and bony abnormalities 1
- MRI provides better soft tissue detail and is superior for detecting subtle abnormalities, though it takes longer and has more contraindications 1
- The American College of Radiology (ACR) has established appropriateness criteria for the use of CT and MRI in various neurological conditions, including head trauma, stroke, and seizures 1
In terms of specific patient populations, CT brain scans are particularly useful in:
- Children with suspected traumatic brain injury, especially those with altered mental status, loss of consciousness, or concerning neurological findings after head trauma 1
- Patients with known intracranial pathology, such as tumors or vascular malformations, who present with new or worsening symptoms 1
Overall, CT brain scans are a valuable diagnostic tool in a wide range of neurological conditions, and their use should be guided by the ACR appropriateness criteria and the individual patient's clinical presentation 1.
From the Research
Indications of CT Brain
The following are indications for CT brain imaging:
- Acute intracranial hemorrhage, particularly in patients with traumatic brain injury and hemorrhagic stroke 2, 3, 4, 5
- Evaluation of skull fractures, which may alter management and lead to further imaging studies 3
- Assessment of mass effect and life-threatening conditions in head trauma patients 3
- Determining the presence, volume, extent, and multiplicity of hematomas in head trauma patients 4
- Evaluation of mild head injuries, particularly in patients with risk factors such as unclear or ambiguous accident history, continued post-traumatic amnesia, trauma above the clavicles, age <60 years, coagulation disorders, and alcohol or drug intoxication 6
- Identification of the cause, location, and severity of intracranial hemorrhage, as well as the risk of impending cerebral injury 5
Specific Conditions
CT brain imaging is useful in the following specific conditions:
- Traumatic brain injury: to identify acute intracranial hemorrhage and evaluate skull fractures 3, 4
- Hemorrhagic stroke: to identify acute intracranial hemorrhage and guide treatment 2, 5
- Mild head injuries: to exclude acute intracranial hemorrhage in patients with risk factors 6
- Intracranial hemorrhage: to identify the cause, location, and severity of hemorrhage, and guide treatment 5