Minerva Anestesiologica 2022 Feb 24

DOI: 10.23736/S0375-9393.22.16200-0

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Head CT for the intensivist: 10 tips and pearls

Sajeev A. MAHENDRAN ¹, Oliver FLOWER ¹, J. Claude HEMPHILL III ² ✉

¹ Malcolm Fisher Intensive Care Unit, Royal North Shore Hospital, Sydney NSW, Australia; ² Department of Neurology, University of California, San Francisco, CA, USA

Head imaging is an essential diagnostic tool for the management of patients with most acute neurological emergencies involving the brain. While numerous modalities including magnetic resonance imaging and catheter angiography play a role, computed tomography (CT) of the brain is far and away the most widely utilized technique because of its widespread availability and the fact that it is usually easier to implement in critically ill and potentially unstable patients. CT is particularly useful in identifying acute intracranial hemorrhage and this makes it often indispensable in the management of patients with traumatic brain injury and hemorrhagic stroke. However, shortcomings in identifying early ischemia on non-contrast CT mean that care must be taken in considering findings early after symptom onset, with newer CT sequences such as CT angiography and CT perfusion adding value. The critical role played by intensivist in managing neurocritical care patients necessitates familiarity and ability with viewing and understanding the advantages and shortcomings of head CT imaging and under which circumstances other modalities may be appropriate to obtain. This manuscript provides ten different circumstances commonly encountered in neurocritical care and how intensivists can use CT for the benefit of their patients.

KEY WORDS: Computed tomography; Traumatic brain injury; Neurocritical care; Stroke