Appropriate initial imaging studies in Neuro as per clinical problems

                      Clinical problem                                             Modality

Fractures / Bony lesions of Skull	CT brain with bone window
Major head trauma	CT (neurologically unstable); MRI (neurologically stable)
Mild head trauma	Observe; CT (if persistent headache)
Acute hemorrhage (Bleed)	Non contrast CT
Suspected intracerebral aneurysm or AV Malformations	MRI Brain with (3D TOF Non Contrast) MR Angiography
Hydrocephalus	Non contrast CT < MRI
Transient Ischemic Attack	Non contrast CT, MRI if vertebro basilar findings; consider carotid Doppler if bruit present.
Recent giddiness and walking imbalance	MRI Brain with 3D TOF Non Contrast MR Angiography
Acute stroke (suspected hemorrhagic)	Noncontrast CT
Acute stroke (suspected non hemorrhagic)	MRI Brain with (3D TOF Non Contrast) MR Angiography
Multiple sclerosis	MRI Brain and Whole Spine screening for Cord
Tumor or metastases	MRI with Contrast
Aneurysm (chronic history)	3D TOF Non Contrast MR Angiography or Contrast CT Angiography
Abscess	Contrast CT / MRI
Preoperative for cranial surgery	Contrast angiography
Meningitis	Lumbar tap; CT Brain only to exclude complications
Seizure (new onset or poor therapeutic response)	MRI (Epilepsy protocol)
Seizure (febrile or alcohol withdrawal without neurologic deficit)	CT / MRI sos
Neurologic deficit with known primary tumor elsewhere	MRI if associated sensorineural findings
Vertigo (if suspect acoustic neuroma or posterior fossa tumor)	MRI with thin sections for Cranial Nerve imaging
Headache	CT Brain covering Para nasal sinuses
Dementia	Nothing, or MRI Brain
Alzheimer’s disease	Nuclear medicine SPECT scan
Sinusitis	CT / MRI Brain with limited axial sections to cover sinuses

Reference: Mettler, Essentials of Radiology, 2nd ed.