[Neuroradiological investigations in mild brain injuries: state of the art and practical recommendations]

Abstract

Objectives: To clarify the contribution of each technique of neuroradiological and nuclear medicine investigations after mild brain injuries. To analyze the pathophysiological mechanisms of the lesions. To update indications for imaging techniques in the short or long term management. To define the practical recommendations.

Method: The international databases were consulted for each neuroradiological technique; the most valuable articles were retained for study (PubMed, ).

Results and discussion: Standard skull X-rays are obsolete. Craniofacial (bony windows) and brain CT-scan (parenchymal windows) is the most efficient diagnosis tool in the acute phase because of its accessibility. Brain MRI is less accessible in the emergency setting but is feasible in some centers. It is the best choice in the first weeks following mild brain injury but may be normal. Taking into account the limitations of morphological imaging, functional imaging techniques (SPECT, fMRI, PET-scan) are necessary as they may show axonal damage or brain atrophy. There is however the problem of availability. SPECT is the most accessible. Spectro-MRI is promising. In spite of progress in neuroradiological investigation methods, the neuropsychological evaluation and multi-disciplinary treatment of these patients by a skilled team remains of utmost importance.