Neuroimaging, Neurodiagnostics, and Multimodal Monitoring
Imaging
Know when to choose CT (fast, detects hemorrhage and fracture, radiation exposure) versus MRI (superior for ischemia, infection, edema, and posterior fossa). Recognize that a normal early CT does not exclude ischemia or raised ICP. Understand that sedation for imaging carries risk and must be balanced against diagnostic need. Know that ultrasound through the fontanel is useful in neonates and that vascular imaging (CT or MR angiography) evaluates stroke and vasculopathy.
Neurodiagnostics
Understand EEG indications: unexplained altered consciousness, nonconvulsive seizure suspicion, status epilepticus management, and prognostication after cardiac arrest. Know that continuous EEG requires electrode care and that electrical interference and sedation affect interpretation. Recognize lumbar puncture as a diagnostic with specific contraindications.
Multimodal monitoring
Combine ICP, CPP, near-infrared spectroscopy, pupillometry, and EEG to build a picture when the exam is limited. Understand that no single number defines adequate perfusion; trends and consistency across modalities guide therapy.
Traps
Questions test that transport to imaging requires stabilization first, that contrast and radiation risks are real in children, and that EEG findings must be interpreted with sedation and temperature in mind.
Rule of thumb
Image to answer a specific question, stabilize before transport, and treat the child, not the picture.