Ten key points about diagnostic brain imaging in ICU: indications, basic interpretation, tips to know and pitfalls to avoid

Diagnostic brain-imaging in the ICU

Abstract

Acute encephalopathy is very common in intensive care, whether as a reason of admission or due to a complication during the stay. Patient’s history and clinical examination are essential but can be overlooked due to the use of mechanical ventilation and sedatives. Brain imaging by computed tomography (CT) and even more by magnetic resonance imaging (MRI), are likely to provide key diagnostic and prognostic elements in a large number of situations. Thanks to the refinement of these techniques and their growing availability, they now are routinely use in practice. Whether to guide therapeutic management in the acute phase of a stroke or head trauma or to help with positive and etiological diagnosis of meningoencephalitis, space occupying lesion or suspected metabolic encephalopathy, the basic technical and interpretation aspects of CT and MRI must therefore be known to the intensivists. In this narrative review, we will present the indications and diagnostic contribution of both CT and MRI in intensive care, as well as some pitfalls to avoid, in ten key points corresponding to different clinical situations.