A patient with deteriorating neurologic signs,including a pupillary change, requires emergent intracranial imaging studies if the airway, breathing, and circulation are stable. Head CT is the fastest, most efficient imaging study for acute evaluation of intracerebral hemorrhage (intraparenchymal, subarachnoid, subdural, or epidural). Acute ischemic stroke is less of a concern in this scenario; thus, transcranial Doppler ultrasound and MRI of the brain are not the best first studies in the emergent period. Cerebral angiography and continuous EEG may be necessary at some point during the evaluation, but not in the emergent setting.
- Gentry LR. Imaging of closed head injury. Radiology. 1994 Apr;191(1):1-17.