Emergency imaging of patients with resolved neurologic deficits: value of immediate cranial CT.

Abstract

The purpose of this study was to evaluate the utility of cranial CT performed emergently in patients with neurologic deficits of acute onset that had resolved by the time of presentation to an emergency department. Data were evaluated from 1518 patients presenting to level I (967 patients) and level II (551 patients) emergency departments. All patients underwent cranial CT during their 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 neurologic 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 examinations, relevant laboratory data, results of CT, and information regarding patients' disposition from the emergency department. All 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 deficits had resolved than in the other 1447 patients who underwent CT for other reasons (chi 2: p < .001). Immediate cranial CT is not indicated in the evaluation of patients with resolved neurologic deficits, except possibly when the patient has a history of trauma.