EMERGENCY IMAGING OF PATIENTS WITH RESERVED NEUROLOGIC DEFICITS - VALUE OF IMMEDIATE CRANIAL CT

OBJECTIVE. The purpose of this study was to evaluate the utility of cr anial CT performed emergently in patients with neurologic deficits of acute onset that had resolved by the time of presentation to an emerge ncy department. MATERIALS AND METHODS. Data were evaluated from 1518 p atients presenting to level I (967 patients) and lever II (551 patient s) emergency departments. All patients underwent cranial CT during the ir visit to the emergency department to exclude potential intracranial hemorrhage or life-threatening mass effect from other causes. Of the 1518 patients who had CT done in one of these two departments and were entered into this study, 71 had histories compatible with resolved ne urologic deficits, including 62 with apparent cerebrovascular disease, six with trauma, and three with seizure. The data collected included demographic information, medical history, physical and neurologic exam inations, relevant laboratory data, results of CT, and information reg arding patients' disposition from the emergency department. RESULTS. A ll CT scans in patients with resolved deficits were normal except for one in a patient who had had trauma. The scan of this patient showed a left frontal bone fracture and a subtle underlying subdural hematoma. These required no therapy. The rate of abnormal findings on CT scans was significantly lower in the 71 patients in whom acute neurologic de ficits had resolved than in the other 1447 patients who underwent CT f or other reasons (chi(2): p <.001). CONCLUSION. Immediate cranial CT i s not indicated in the evaluation of patients with resolved neurologic deficits, except possibly when the patient has a history of trauma.