MRI Brain Scans

MRI Brain Scans in ER: Problem Solving Game Changer

By Dr/ Heba Abdelmoez - Rology Radiologist

فحوصات الدماغ بالرنين المغناطيسي Doctor looking to MRI Brain Scans

The ER is full of Disturbed Level of Consciousness patients for many causes. History taking and clinical examination help narrow the differential diagnosis for the possible causes. The expertise clinician  always has his primary suspicion that can be either confirmed or disproved by an MRI.
Below we share the most common possible clinical scenarios of DCL patient cases that arise in the night shifts in the ER ward’

Stroke:

This is the most common. Patients suffering strokes feel like their lives are a tornado’. Nothing is the same after a patient gets a stroke. So keep it in mind and exclude it first. DWI is the role player in this diagnosis. DWI restriction in a vascular territory is mostly conclusive.

Metabolic Toxic Consequences:

This diagnosis suspicion may be raised in 

  • Diabetic patients presenting with Hyper or hypoglycemic coma, 
  • Renal patient with coma, 
  • pregnant lady having hyperemesis gravidarum and coming to ER department with a confused status 

Bilateral symmetrical white matter involvement with and without Basal ganglia involvement is highly indicative of metabolic encephalopathy.

Venous Thrombosis: 

This is a scenario to keep in mind. A female patient on oral CCPs with sudden delirium. Suspect venous thrombosis and order an MRI study with MRV. Non-opacification of one of the venous sinuses is diagnostic. It may be associated with or without intracranial hemorrhage.

Benign Increase in Intracranial Pressure:

This may be a young female, healthy with sudden papillodema and headache. Look at the peri-optic CSF space, sure they will be dilated along with empty sella. The MRV scan may show stenotic dural sinus. The correct diagnosis will offer this patient the correct treatment.

CNS Infection

Since HIV is rapidly spreading, patients can face an MRI exam that reveals ring-enhancing lesions. Be calm and think in logical order, look at the DWI, and decide whether they are restricted or not (MRS is helpful in such cases). Lipid peaks are characteristic of brain Tuberculous infection. Lymphoma is also a diagnosis to keep in mind in such cases as many of HIV patients develop CNS lymphoma

Multiple medical conditions could be the cause of Disturbed Level of Consciousness in patients. Clinically oriented-radiologists help reduce the time needed to reach the correct diagnosis. We at Rology have this perspective and work to reduce the turnaround time, offer evidence-based standard imaging protocol according to the patient’s clinical history suspicion, communicate with the patient and doctors, provide subspecialty reporting of the imaging study, and thoroughly review the entire teleradiology process to provide the best solution. Ultimately this supports our mission of saving lives.

Rology is the leading AI-assisted teleradiology platform in the Middle East & Africa. Our goal is to save lives by reducing turnaround time and providing accurate and timely diagnoses. Contact us at info@rology.net to learn more about our services and how we can support you as a healthcare provider.