Traumatic brain injury and traumatic spinal cord injury are major causes of morbidity and mortality, necessitating rapid and accurate diagnostic evaluation. Neuroimaging plays a critical role in the early assessment and management of these conditions, allowing for the timely identification of hemorrhagic lesions, cerebral edema, vascular injuries, and spinal cord pathology that may require urgent intervention. In this review, we use a time-based approach to appraise the role of imaging in the hyperacute (first 24 hours) and acute (up to 1 week) periods postinjury. Although computed tomography imaging guides most decision-making in trauma, we also highlight the role of ultrasound imaging modalities such as transcranial Doppler and optic nerve sheath diameter monitoring for noninvasive ICP monitoring, and magnetic resonance imaging for prognostication. Cases are used to highlight imaging findings that may change management in the hyperacute and acute period.
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