Use of Brain Images in Neurological Diseases
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Source: Gilman S. N Engl J Med 1998; 338:812-819.
In two medical progress articles, gilman usefully describes and discusses the use of brain images in neurological diseases. With the permission of the New England Journal of Medicine and the author, we publish this Table from the article. Most of the identified disorders require brain imaging for current standards of immediate care. Those marked by an "x" by Alert's editor are optional, and the expense of their performance should be considered carefully against their expected usefulness. Once a diagnostic MRI identifies multiple sclerosis, for example, repeated scans have little value except during commercial drug trials. Similar or greater restraint applies to routine examples of the other optional guidelines. (Fred Plum, MD, Neurologist-in-Chief, New York Hospital-Cornell Medical Center.)
Table
| Neurologic Disease | Imaging Procedure |
| Cerebral or cerebellar ischemic infarction | CT in the first 12-24 hr; MRI after 12-24 hr (diffusion-weighted and perfusion-weighted MRI augments the findings, especially in the first 24 hr, and even before 8 hr). |
| Cerebral or cerebellar hemorrhage | CT in the first 24 hr; MRI after 24 hr; MRI and endovascular angiography for suspected arteriovenous malformation. |
| Transient ischemic attack | MRI to identify lacunar or other small lesions; ultrasound studies of the carotid arteries; MRA. |
| Arteriovenous malformation | CT for acute hemorrhage; MRI and endovascular angiography as early as possible. |
| Cerebral aneurysm | CT for acute subarachnoid hemorrhage; CT angiography or endovascular angiography to identify aneurysm; TCD to detect vasospasms. |
| Brain tumor | MRI without and with injection of contrast material. |
| Craniocerebral trauma | CT initially; MRI after initial assessment and treatment. |
| x Multiple sclerosis | MRI without and with injection of contrast material. |
| Meningitis or encephalitis | CT without and with injection of contrast material initially, MRI after initial assessment and treatment. |
| Cerebral or cerebellar abscess | CT without and with injection of contrast material for initial diagnosis or, if stable, MRI. MRI without and with injection of contrast material subsequently. |
| Granuloma | MRI without and with injection of contrast material. |
| x Dementia | MRI; PET; SPECT. |
| x Movement disorders | MRI; PET. |
| Neonatal and development | Ultrasound in unstable premature disorders neonates; otherwise MRI. |
| x Epilepsy | MRI; PET; SPECT. |
| x Headache | CT in patients suspected of having structural disorders. |
Adapted with permission from Gilman S. N Engl J Med 1998;338:812-819. Copyright 1998 Massachusetts Medical Society. All rights reserved.
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