Abstract
The use of neuroimaging in conjunction with serial neurological examinations is a
core component of modern neurocritical care practice. Although there is a growing
role for other neuromonitoring techniques, the ability to quickly and accurately interpret
images in the context of a patient's clinical status arguably remains the indispensable
skill for neurocritical care practitioners. Due to its rapid acquisition time and
excellent ability to detect intracerebral hemorrhage (ICH), cerebral edema, and signs
of elevated intracranial pressure, computed tomography (CT) remains the most useful
neuroimaging technique for intensive care unit (ICU) patients. An emergent head CT
is obtained to inform most time-sensitive decisions that arise in the neurological
ICU (NICU). CT features also figure prominently in prognostic scores for common NICU
conditions such as traumatic brain injury (TBI), ICH, and subarachnoid hemorrhage
(SAH). Among patients who are sufficiently stable to leave the ICU and lie flat for
an extended period, magnetic resonance imaging provides much more detailed, high-contrast
images which can aid in the detection of ischemia, diffuse axonal injury, and neuroprognostication.
Though primarily used in neurocritical care research, nuclear medicine imaging techniques
have some clinical applications, particularly in ancillary testing for brain death.
Finally, as in the field of critical care as a whole, formal and point-of-care ultrasound
studies are increasingly utilized in the NICU, and are an important tool in the neurointensivist's
armamentarium. We review here the common applications of imaging in the neurocritical
care setting. As ICU patients are frequently unstable and their risk of clinical decompensation
increases substantially during transport away from the ICU, guidelines and recommendations
for maximizing patient safety during transport to radiology studies are also explored.
Keywords
neuroimaging - critical care - ICU
