The first step is a CT of the brain without IV contrast for trauma, CVA, TIA, dementia, atrophy, hemorrhage, alcohol-induced seizures, acute seizure disorder, or in the case of a patient who is unable to consent for the use of IV contrast. Alternatively, the first step is a CT of the brain with and without IV contrast for the evaluation of tumor, metastases, aneurysm, AVM, infection, or the complete elective evaluation of seizure disorder (new onset or non-alcoholic seizures). Occasionally a contrast study will be required for the evaluation of a subacute subdural hematoma. For patients being screened for brain metastases (lung, breast etc.), but without symptoms, CT of the brain with and without contrast is suggested. However, in patients with suspected metastases to the brain who are symptomatic, MRI is a better first step in evaluation. In many cases when brain tumor is clinically felt to be likely, the first examination will be MRI with and without IV contrast. MRI is otherwise generally reserved for complex problem solving such as MS, subtle infection, complete tumor evaluation, MRA for vascular disorders or other indications. Please consult with a neuroradiologist (phone 3681) as needed.