Imaging in coma

Recent advances in neuroimaging have increased our diagnostic ability. Computed tomography (CT) and magnetic resonance imaging (MRI) are the two techniques used in acutely ill adults. CT is the investigation of choice in trauma, subarachnoid haemorrhage, or stroke. It is readily available, quick and virtually all patients can be scanned. MRI provides images in several planes and provides superior grey/white matter contrast with a high sensitivity for most pathological processes compared with CT. MRI would be the investigation of choice in suspected posterior fossa lesions, epilepsy, and inflammatory processes. MRI is also more sensitive for thin extradural haematomas and diffuse axonal injury in trauma but requires special consideration for anaesthetised patients because of the interference from the electromagnetic field to anaesthetic and monitoring equipment.

Brain imaging is usually undertaken as soon as A, B, C are stable and a full evaluation has led to a differential diagnosis. When imaging is undertaken, it should lead to a diagnosis or have the potential to change management.

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