The basic modalities for imaging the head are CT and MRI.
CT: the study of choice for hemorrhage, hydrocephalus, and skull fracture.
MRI: the study for tumor and multiple sclerosis.
Angiogram: “Virtual” angiogram with CT-A, MR-A, and the “Real” 4-vessel Femoral-Cerebral arteriogram.
CT Head is the most common cranial imaging study you’ll see. It’s as common in neurosurgery as a chest x-ray is in internal medicine. And just like the chest x-ray, you need to approach it systematically.
A 57 year old female presented with new onset seizure. An MRI was obtained showing a lesion in the right frontal/parietal region. You can see there is some mass effect, slight effacement of the ventricle, and a whiff of enhancement.
A 25 year old male college student presents to the ER with complaint of sudden severe headache with an episode of vomiting. On exam he looks uncomfortable but is neurologically normal, that is, he is awake, oriented fully, moving arms and legs without weakness or neglect.
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.
Subdural hematoma is a common neurosurgical problem. A subdural usually occurs in patients with significant brain atrophy, such as the elderly or alcoholic. Even minor trauma can injure the bridging veins between the brain and the dura.