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Out of hours imaging of acute neurological disease

Department of Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK

• Focal neurological signs or deteriorating conscious level require urgent CT.
  
• Acute stroke alone does not require urgent CT unless thrombolytic treatment is considered or the patient is on anticoagulants.
  
• Suspected meningitis does not require CT prior to lumbar puncture (LP). Patient confusion is common and alone does not indicate raised intracranial pressure.
  
• CT should become the investigation of choice for any case of suspected significant head injury.
  
• Acute subarachnoid haemorrhage (SAH) of good grade patients (fully conscious with no signs) does not require out of hours CT except in centres where out of hours treatment will follow.
  
• There is no evidence that LP is dangerous in good grade patients and may be performed if there are geographical constraints or a lack of CT availability. Many centres will offer CT for all cases of suspected SAH.
  
• Headaches taking minutes to develop are unlikely to be owing to SAH.
  

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