In a small proportion of patients, brain MRI did reveal acute pathology possibly accounting for delirium, including ischemic and hemorrhagic stroke, subdural hematoma, SAH, septic emboli, encephalitis, meningitis, cerebral metastases, primary brain tumor, pineal tumor, and a large meningioma [34]. MRI may be helpful for further evaluation of an abnormality detected on noncontrast CT in the workup of new onset delirium, such as space-occupying lesions or infection. CT Head With IV Contrast Contrast-enhanced CT examinations may be considered if clinical concern exists for progression of intracranial infection, such as abscesses or empyema, tumor, or inflammatory conditions. Advantages of CT are fast examination times and less susceptibility to motion artifact compared with MRI. Disadvantages of CT include less sensitivity in detection of acute ischemia and enhancement compared with MRI [30]. Overall, MRI is considered superior in this clinical scenario. CT Head Without and With IV Contrast A common practice is to perform a noncontrast screening head CT followed by a more sensitive MRI brain examination performed with and without IV contrast in the setting of AMS. 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. CT Head Without IV Contrast CT is the first-line imaging test of choice for evaluating suspected progressive ICH, mass effect, or hydrocephalus in the emergent setting. Noncontrast head CT examinations are able to depict possible complications of a wide variety of intracranial pathology, including progressive mass effect, increasing edema, hydrocephalus, new or enlarging ICH, and progressive ischemia. However, the literature search did not identify any studies regarding the 6 Altered Mental Status, Coma, Delirium, and Psychosis use of CT in the evaluation of acute or worsening mental status changes in a patient with known intracranial pathology.
Altered Mental Status Coma Delirium and Psychosis. In a small proportion of patients, brain MRI did reveal acute pathology possibly accounting for delirium, including ischemic and hemorrhagic stroke, subdural hematoma, SAH, septic emboli, encephalitis, meningitis, cerebral metastases, primary brain tumor, pineal tumor, and a large meningioma [34]. MRI may be helpful for further evaluation of an abnormality detected on noncontrast CT in the workup of new onset delirium, such as space-occupying lesions or infection. CT Head With IV Contrast Contrast-enhanced CT examinations may be considered if clinical concern exists for progression of intracranial infection, such as abscesses or empyema, tumor, or inflammatory conditions. Advantages of CT are fast examination times and less susceptibility to motion artifact compared with MRI. Disadvantages of CT include less sensitivity in detection of acute ischemia and enhancement compared with MRI [30]. Overall, MRI is considered superior in this clinical scenario. CT Head Without and With IV Contrast A common practice is to perform a noncontrast screening head CT followed by a more sensitive MRI brain examination performed with and without IV contrast in the setting of AMS. 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. CT Head Without IV Contrast CT is the first-line imaging test of choice for evaluating suspected progressive ICH, mass effect, or hydrocephalus in the emergent setting. Noncontrast head CT examinations are able to depict possible complications of a wide variety of intracranial pathology, including progressive mass effect, increasing edema, hydrocephalus, new or enlarging ICH, and progressive ischemia. However, the literature search did not identify any studies regarding the 6 Altered Mental Status, Coma, Delirium, and Psychosis use of CT in the evaluation of acute or worsening mental status changes in a patient with known intracranial pathology.