When to get a CT Head

When to get a head CT?

How do you know when to order a head CT? A patient presents with headache or confusion: should you get a scan now? Here is a mnemonic that can help you know when to get a head CT on a patient with neurological symptoms.

SCAN – NOW. Get a CT Head if . . .

Seizure: new onset seizure

Confusion, or any change in mental status

Acute onset: a “new and different” headache

Nuchal rigidity: the stiff neck of meningitis or subarachnoid hemorrhage

Neuro deficit: any focal neuro change, like unequal pupils or pronator drift

Optic papilledema: a sign of increased intracranial pressure

Worrisome history: like malignancy, anticoagulants, or prior bleed or known lesion

For the patient with complaint of headache, always ask, “Is this the same old headache that’s bothered you so long … or IS THIS NEW AND DIFFERENT?” The “new and different headache” needs a CT.

For the headache patient, always perform a funduscopic exam, looking for optic papilledema, a sign of increased intracranial pressure. Every headache workup needs a funduscopic exam!

Nuchal rigidity is a classic sign of meningitis and is caused by the irritation of the meninges caused by bacteria and white blood cells in the CSF. This irritation is heightened by flexion of the neck, as the meninges are stretched. In a subarachnoid hemorrhage, red blood cells in the CSF cause a similar irritation of the meninges, aggravated by neck flexion. This nuchal rigidity is also associated with Kernig’s sign and Brudzinski’s sign. Any patient with headache and nuchal rigidy requires an immediate CT of the head. (And in the presence of acute illness or fever suggesting meningitis, immediate administration of antibiotics, even before the diagnostic workup is completed.)

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s