Other imaging modalities

Ultrasound

This technique, which is useful in other areas, has found only limited application in the central nervous system. A major advantage is that it can be brought to the bedside. It can be used to detect intracranial hemorrhage and hydrocephalus in the postoperative patient, but in practice the views are usually too restricted to be sufficiently reliable and CT is preferred. Doppler ultrasound reliably detects carotid stenosis and occlusion. Transcranial Doppler can provide information about flow in major intracranial arteries and has been used to cue use of spasmolytic drugs in subarachnoid hemorrhage and exchange transfusion in sickle cell disease, but its reliability cannot be accepted without question.

Nuclear medicine

Outside medical research the roles of nuclear medicine in patient care are continuing to contract rather than expand. Some specialized units with the appropriate facilities may use techniques such as single-photon-emission CT (SPECT) to make clinical observations on cerebral blood flow, which may cue various interventions, or to establish brain death, but in practice little information is provided that cannot be obtained or deduced, often more reliably, in other ways.

Cerebral angiography

Conventional or digital subtraction angiography is virtually never indicated in the critically ill patient. It is still needed to diagnose some aneurysms and arteriovenous malformations, and the site of torrential bleeding, particularly when endovascular treatments are contemplated.

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