MRI Head With IV Contrast There is no relevant literature to support the use of MRI head performed only with IV contrast in this clinical scenario. MRI Head Without and With IV Contrast MRI examinations without and with IV contrast may be performed if intracranial infection, tumor, inflammatory lesions, or vascular pathologies are suspected. However, the literature search did not identify any studies regarding the use of contrast-enhanced MRI relevant to this variant. Noncontrast MRI examinations of the brain are usually sufficient in the assessment of intracranial complications related to hypertensive emergency, including posterior reversible encephalopathy syndrome. Variant 5: Adult. New onset psychosis. Initial imaging. This variant addresses the role of neuroimaging in the assessment for secondary causes of new onset psychosis in the ED or inpatient setting. Some of the reported organic causes of psychosis include tumors or infarcts in specific areas of the brain, such as the temporal lobe, systemic lupus erythematosus, encephalitis, multiple sclerosis, Wilson disease, Huntington disease, or metachromatic leukodystrophy [42-44]. Patients with new onset psychosis who have suspected stroke, focal neurologic deficit, seizure, head trauma, or headache should refer to the respective ACR Appropriateness Criteria as appropriate: ACR Appropriateness CT Head With IV Contrast Contrast-enhanced CT is generally not helpful for new onset psychosis in the absence of focal neurologic deficits. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT head without and with IV contrast in the initial imaging of this clinical scenario. MRI Head With IV Contrast There is no relevant literature to support the use of MRI head performed only with IV contrast in this clinical scenario.
Altered Mental Status Coma Delirium and Psychosis. MRI Head With IV Contrast There is no relevant literature to support the use of MRI head performed only with IV contrast in this clinical scenario. MRI Head Without and With IV Contrast MRI examinations without and with IV contrast may be performed if intracranial infection, tumor, inflammatory lesions, or vascular pathologies are suspected. However, the literature search did not identify any studies regarding the use of contrast-enhanced MRI relevant to this variant. Noncontrast MRI examinations of the brain are usually sufficient in the assessment of intracranial complications related to hypertensive emergency, including posterior reversible encephalopathy syndrome. Variant 5: Adult. New onset psychosis. Initial imaging. This variant addresses the role of neuroimaging in the assessment for secondary causes of new onset psychosis in the ED or inpatient setting. Some of the reported organic causes of psychosis include tumors or infarcts in specific areas of the brain, such as the temporal lobe, systemic lupus erythematosus, encephalitis, multiple sclerosis, Wilson disease, Huntington disease, or metachromatic leukodystrophy [42-44]. Patients with new onset psychosis who have suspected stroke, focal neurologic deficit, seizure, head trauma, or headache should refer to the respective ACR Appropriateness Criteria as appropriate: ACR Appropriateness CT Head With IV Contrast Contrast-enhanced CT is generally not helpful for new onset psychosis in the absence of focal neurologic deficits. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT head without and with IV contrast in the initial imaging of this clinical scenario. MRI Head With IV Contrast There is no relevant literature to support the use of MRI head performed only with IV contrast in this clinical scenario.