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Head computed tomography (CT) is one of the most common imaging studies ordered from the ED. Head CT is used in the evaluation of the patient who presents with headache, altered mental status, suspected stroke, or other acute neurological abnormalities. Current third-generation CT scanners are very sensitive for the detection of acute hemorrhage and bony injury, the two principal pathologies sought in evaluation of patients with head injury. In the patient with head injury, head CT will readily identify skull fractures, although fractures through the thinnest areas of the base of the skull may be missed in the axial cuts. In patients with altered mental status and other neurological abnormalities, head CT is extremely valuable in detecting pathology that requires emergent intervention. The vast majority of head CTs performed in the ED are done without contrast. Artifact is an important consideration in the interpretation of head CTs.
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