Indications for a Head CT in Adult Patients with Headache

1. Suspected Cerebrovascular Accident

a. differentiate between hemorrhagic and ischemic CVA

b. more sensitive than LP for blood

2. Suspected brain tumor- headache plus focal neurological signs, paraneoplastic syndromes, slowly progressive loss of neurologic function, nausea/vomitting

a. will be able to find tumors greater than 2-4mm

b. need to use IV contrast to differentiate enhancing (most gliomas, most MS lesions, toxoplasmosis) versus non-enhancing lesions (HIV encephalopathy, some gliomas, some lesions in MS, HSV encephalitis)

3. Hydrocephalus- elderly platient with difficulty walking, personality changes, and new-onset incontinence or other such concerns

4. Evaluation of traumatic Head Injury (r/o Epidural and Subdural hematomas)

a. CT Head in every severe head injury (GCS <8,>

b. CT Head in every moderate head injury (GCS 9-13, lethargic, somnolent)

c. CT Head in some cases of mild head injury

i. Glasgow Coma Scale <15>

ii. Open or depressed skull fracture

iii. Vomiting (Two or more episodes)

iv. Age 65 years or over (other studies suggest age 60)

v. Basal skull fracture signs

1. Hemotympanum

2. Periorbital Bruising (Raccoon's Eyes)

3. Mastoid process Ecchymosis (Battle's Sign)

4. Cerebrospinal fluid leakage from ear or nose

5. To evaluate for meningitis/other pathology in cases with suspected or known increased ICP which would make LP difficult and dangerous given the risk for herniation.

6. New onset AM headaches, extremely severe/crippling headaches, certain complex migranes (with symptoms of numbness/tingling in limbs, loss of function/paralysis, etc), intractable nausea/emesis

Category: Radiology Notes