Monitoring
Noncontrast head computed tomography (CT) is usually appropriate for the short-term follow-up imaging of patients with acute head trauma who have unchanged neurologic examination and positive finding(s) on initial imaging such as subdural hematoma (SDH).[48] Magnetic resonance imaging may be indicated as a follow-up study when there are persistent neurologic deficits that remain unexplained after the head CT.[48] Routine follow-up scans in patients with a Glasgow Coma Scale score of 13 to 15 are unlikely to show progression requiring intervention in the absence of progressive neurologic decline.[197] Radiographic imaging should be obtained immediately in the case of new neurologic symptoms, headache, nausea, vomiting, or dizziness. Neurosurgical follow-up is essential.
One randomized controlled trial found no benefit for routine follow-up CT after surgery for chronic SDH and concluded CT may only be indicated if there is cause for concern (e.g., clinical deterioration or persisting neurologic deficits).[198]
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