Which imaging study is typically first-line in an acutely ill child with suspected intracranial pathology and altered level of consciousness?

• A. MRI head without contrast
• B. Ultrasound of the head
• C. Non-contrast CT head
• D. X-ray skull

Answer: (C)

When a child is acutely ill with suspected intracranial pathology and altered consciousness, the priority is to rapidly identify life-threatening issues such as acute hemorrhage, mass effect, edema, or hydrocephalus. A non-contrast CT scan of the head best meets this need because it is fast, widely available, and highly sensitive for acute bleeding and structural problems. It can be performed quickly in the emergency setting and often without need for sedation, enabling prompt decision-making.

MRI provides greater detail for many brain conditions but takes longer, may require transporting a unstable patient and sedation, and thus delays urgent management. Ultrasound of the head is mainly helpful in neonates with open fontanelles and has limited utility for detecting acute intracranial pathology in older children. Skull X-rays lack sensitivity for most acute intracranial processes.