Neurodiagnostic studies and the management of head injury

The rational management of patients with head injury calls for the closest cooperation between the radiologist and neurosurgeon. Until the last three to four years, cerebral angiography had been considered the diagnostic procedure of choice for the management of patients with suspected traumatically induced intracranial mass lesions. Experience with CT scanning now indicates that for a number of reasons this procedure is to be preferred in the diagnosis of head injuries. It is more rapid than angiography, routinely visualizes the entire brain, is noninvasive, resolves lesions that are much smaller than any visualized by angiography and defines the density and thus the nature of traumatic lesions in a manner not possible with previously employed techniques. Using CT scanning in a sequential fashion we have routinely been able to visualize the appearance of new lesions in the post-traumatic period and have as well, been able to develop insights into the temporal appearance and disappearance of white matter edema as measured by Hounsfield numbers. In the late post-traumatic period, it has been valuable in defining hydrocephalus, porencephaly and other post-traumatic lesions that have a significant bearing on both therapy and prognosis.