Which first-line imaging technique in non-traumatic coma in 2012?

Abstract

Causes of non-traumatic coma are multiple, including vascular (basilar artery occlusion, bilateral thalamic infarction, deep cerebral venous system thrombosis, aneurismal subarachnoïd hemorrhage, cocaine overdose, posterior reversible encephalopathy), metabolic (hypoglycemic encephalopathy, central pontine and extrapontine myelinolysis, hepatic encephalopathy), and toxic (carbon monoxide or methanol poisoning, Marchiafava-Bignami disease, Gayet-Wernicke encephalopathy), as well related to a tumor, an infection, status epilepticus seizures, and cerebral anoxia. Routinely, due to its availability and acquisition speed, CT-scan is the first-line screening tool at the acute phase. The main objective of CT-scan is to rule out intracranial hemorrhage or space-occupying process. However, its sensitivity is insufficient and MRI is increasingly performed for the etiologic diagnosis of non-traumatic coma to detect brain damage, allowing earlier diagnosis of the causal disease and, in some cases, to introduce a specific treatment.