1.     Any patient presenting with a first time seizure


2.     Patients with a known seizure disorder with recurrent seizures and any of the following:

a.      Clinical suspicion of a structural lesion

b.      Persistent altered mental status

c.      Fever

d.      Recent trauma

e.      Persistent headache

f.  History of cancer

g.      History of anticoagulation

h.      Suspected or confirmed AIDS

i.   New seizure type or pattern


3.     Head trauma in the adult and pediatric population and any one of the following:

a.      Loss of consciousness

b.      Penetrating trauma to the head

c.      Multisystem trauma

d.      Presence of a bleeding disorder

e.      Focal neurologic signs

**  Note:  Minor head trauma including a witnessed bump to the head with no LOC and an otherwise normal exam in an otherwise normal patient may not require a CT of the brain**


4.     Headache with any one of the following:

a.      Acute sudden-onset headache

b.      Focal neurological deficit

c.      Altered mental status

d.      Altered cognitive function

e.      Suspected or confirmed HIV

f.  Over age 50 with a new type of headache


5.     Patients presenting with altered mental status and any one of the following:

a.      Headache

b.      Suspected or confirmed HIV

c.      Use of anticoagulants

d.      Chronic alcohol use

e.      Significant hypertension

f.  Significant hypoventilation

g.      Focal neurologic signs including anisocoria, pinpoint pupils or papilledema

h.      Meningismus


Syncope:  in general the evaluation of syncope without focal neurologic signs does not require an urgent/emergent CT of the brain.