Assistant Professor of Child Neurology Stanford University School of Medicine Palo Alto, California
Edward J. Richer, MD
Assistant Professor of Pediatric Radiology University of Michigan/C.S. Mott Children’s Hospital Ann Arbor, Michigan
Jeffrey R. Strawn, MD
Associate Professor of Psychiatry University of Cincinnati College of Medicine Cincinnati, Ohio Associate Editor, Child and Adolescent Psychiatry, Current Psychiatry
Disclosures
Drs. O’Malley and Richer report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products. Dr. Strawn has received research support from Eli Lilly and Company, Edgemont Pharmaceuticals, Shire, Lundbeck, and Forest Research Laboratories/Allergan. He receives material support from Assurex Health/GeneSight.
“What neuroimaging studies are appropriate, based on my differential diagnosis?”
“Are there specific imaging sequences that we should consider?”
“Are there contraindications to the imaging modality for my patient?”
“Is my patient likely to have difficulty tolerating the imaging procedure?”
“Does my patient need sedation to tolerate this procedure?”
“Should additional regions be included in the scan?” (Examples: In a child with stroke it might be important to include neck and chest vasculature and the heart. Other conditions might warrant imaging of the spinal cord.)
Bottom Line
Making appropriate decisions about neuroimaging in children who have a psychiatric disorder depends on an excellent medical history and physical exam (including a neurologic exam). In the absence of abnormal neurologic findings, neuroimaging is often unnecessary. In the event that there is concern for an acute change in neurologic status, head CT can be obtained quickly and efficiently; otherwise, the preferred pediatric neuroimaging modality is typically MRI, given its superior resolution. It is important to consider expanded imaging options such as dedicated vessel imaging and magnetic resonance spectroscopy when appropriate.
Related Resources
American Academy of Child and Adolescent Psychiatry Resource Center. http://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Home.aspx.
Pediatric NeuroLogic Exam (a learning tool). http://library.med.utah.edu/pedineurologicexam/html/home_exam.html.
