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Introduction

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While not widely accessible, portable computerized axial tomography (CT) scanning (Figure 22-1) has become available commercially and is ideal for the intensive care unit (ICU) patient, who may be at risk during transportation to and from the remotely located CT scanner.

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Figure 22-1.
Graphic Jump Location

CT scanning console in the foreground, with an ICU patient in CT gantry in the background.

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Definitions and Terms

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  • ▪  Neurological emergency: Unexplained change in mental status, obtundation, or neurological deficit

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Techniques

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  • ▪  CT scan with or without contrast is the standard approach to the radiographic determination of intracranial anatomy and pathology.
  • ▪  Noncontrast CT can be used to reveal intracranial hemorrhage, large cerebrovascular events, skull trauma and evaluate ventricular size.
  • ▪  Contrast enhancement is used to evaluate specific lesions which will become more apparent to the presence of contrast in the blood flowing through the lesion, that is, infection or tumor.

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Clinical Pearls and Pitfalls

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  • ▪  Contrast dye may be unnecessary for certain patients and contraindicated for other (ie, renal insufficiency, contrast dye allergy).
  • ▪  Contrast dye can cause afferent arteriolar vasospasm in the kidney, and patients with certain conditions (ie, diabetes, myeloma, renal insufficiency, dehydration, and congestive heart failure) are at increased risk.
  • ▪  Prophylactic hydration reduces the risk of contrast nephropathy, as may prophylactic administration of N-acetylcysteine.

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Suggested Reading

Teichgraber UKM, Pinkernelle J, Jurgensen J, Ricke J, Kaisers U. Portable computed tomography performed on the intensive care unit. Intensive Care Med. 2003;29:491–495.  [PubMed: 12545344]

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