Marion Smits MD, PhD, Presenter: Nothing to Disclose

1) To know the modalities (CT/MRI) and protocols for non-traumatic neurological emergencies. 2) To know and diagnose the main non-traumatic neurological vascular and non-vascular emergencies. 3) To be aware of the pitfalls and limitations of clinical presentation and imaging findings in non-traumatic neurological emergencies.

Neurological emergencies are often associated with high morbidity and mortality, and thus require prompt diagnostic and therapeutic action. Non-traumatic emergencies may however have a subacute onset, and radiological signs may be subtle, which can lead to delay in diagnosis and treatment. Since clinical features are often nonspecific, the radiologist may be the first to point the clinician in the direction of the correct diagnosis. It is therefore of great importance that the radiologist is aware of and familiar with the various imaging findings, on both computed tomography (CT) and magnetic resonance imaging (MRI), of non-traumatic neurological emergencies. These include vascular, infectious and inflammatory diseases. Commonly encountered emergencies are ischaemic and haemorrhage stroke, venous thrombosis, arterial dissection, abscess, acute disseminated encephalomyelitis (ADEM), and encephalitis. Radiological findings in rarer diseases may mimic those in the more commonly occurring diseases, but need to be correctly interpreted as therapeutic strategies and prognosis may be entirely different. Such entities include for instance posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome, Susac’s syndrome, and status epilepticus. Furthermore, initial findings of (impending) complications of brain disease, such as hydrocephalus and herniation of brain structures, may be subtle, while early recognition allows for prompt and adequate intervention. Finally, diagnostic and therapeutic interventions performed in an emergency setting may interfere with the diagnosis and interpretation of clinical and imaging findings. Associated limitations and pitfalls therefore need to be recognised to avoid false negative or false positive diagnosis respectively.

Smits, M, CNS Non-Traumatic Emergencies .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/13011109.html