Neuroimaging: CT Scan and MRI

Neuroimaging, when used together with serial neurological examinations, is a crucial aspect of modern neurocritical care practice. Despite the emergence of other neuromonitoring techniques, the ability to rapidly and accurately interpret images in the context of a patient’s clinical condition remains an indispensable skill for neurocritical care practitioners. Computed tomography (CT) remains the most valuable neuroimaging technique for patients in the intensive care unit (ICU) due to its quick acquisition time and excellent ability to detect intracerebral hemorrhage (ICH), cerebral edema, and indications of elevated intracranial pressure. An emergent head CT is typically obtained to inform urgent decisions that arise in the neurological ICU (NICU). CT features also play a significant role in prognostic scores for common NICU conditions such as traumatic brain injury (TBI), ICH, and subarachnoid hemorrhage (SAH). Magnetic resonance imaging provides much more detailed, high-contrast images that can assist in the detection of ischemia, diffuse axonal injury, and neuroprognostication, particularly for patients who are stable enough to leave the ICU and lie flat for an extended period. It is essential to consider the potential postprocedural complications that may arise in ICU patients when evaluating imaging.