Repetitive Head Injury Syndrome Guidelines

Updated: Aug 19, 2021
  • Author: David Xavier Cifu, MD; Chief Editor: Craig C Young, MD  more...
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Guidelines

Guidelines Summary

Guidelines for the evaluation of patients with head trauma were published in May 2021 by the American College of Radiology. [77]  These are some of the highlights of the guidelines.

For initial imaging of patients with mild (Glasgow Coma Scale [GCS] 13-15) acute head trauma when imaging is not indicated by a clinical decision rule, imaging is usually not appropriate.

For initial imaging of patients with mild acute head trauma when imaging is indicated by a clinical decision rule, noncontrast computed tomography (CT) of the head is usually appropriate.

For initial imaging of patients with acute head trauma that is moderate (GCS 9-12) or severe (GCS 3-8) or penetrating, noncontrast head CT is usually appropriate.

For short-term follow-up imaging of patients with acute head trauma who have an unchanged neurologic examination and unremarkable initial imaging, especially when the neurologic examination is abnormal (GCS < 15), noncontrast brain magnetic resonance imaging (MRI) or noncontrast head CT may be appropriate.

For short-term follow-up imaging of patients with acute head trauma who have an unchanged neurologic examination and one or more positive findings (eg, subdural hematoma) on initial imaging, noncontrast head CT is usually appropriate. Some such patients (eg, those with a normal neurologic examination and intracranial hemorrhage < 10 mL) may not require routine repeat imaging.

For short-term follow-up imaging of patients with acute head trauma who have a new or progressive neurologic deficit, noncontrast head CT is usually appropriate.

For initial imaging of patients with subacute or chronic head trauma and an unexplained cognitive or neurologic deficit, noncontrast brain MRI or noncontrast head CT is usually appropriate; these procedures are equivalent alternatives, and only one need be ordered in this setting.

For patients with head trauma and suspected intracranial arterial injury due to clinical risk factors or positive findings on prior imaging, CT angiography (CTA) of the head and neck is usually appropriate.

For patients with head trauma and suspected intracranial venous injury due to clinical risk factors or positive findings on prior imaging, CT venography (CTV) of the head is usually appropriate.

For initial imaging of patients with head trauma and suspected cerebrospinal fluid (CSF) leakage, noncontrast head CT, noncontrast maxillofacial CT, and noncontrast temporal bone CT are usually appropriate; depending on the clinical setting, these procedures can be complementary or concurrent.