Evaluating the yield of brain CT examinations in patients presenting with first onset seizures at the Groote Schuur Hospital, Cape Town
Background: Seizures are a frequent and potentially significant presenting complaint to the emergency department (ED). Determining the underlying cause for seizures is important in guiding further clinical management of patients. ED physicians at Groote Schuur Hospital, Cape Town, South Africa routinely request Computed Tomography (CT) brain scans in the work-up of patients presenting with first onset seizures. Objectives: To determine the number and proportion of CT scan examinations with abnormal findings in patients presenting with first onset seizures at the Groote Schuur Hospital ED, Cape Town, South Africa and to identify the range of CT abnormalities. Method: A retrospective study was carried out in the Division of Radiology, Groote Schuur Hospital. Patients who presented to the ED with first onset seizures and who underwent brain CT examination as part of their work up between 1 January 2013 and 31 December 2016 were enrolled. All patients presenting to the ED with first onset focal or grand mal seizures were included. Patients with recent trauma and those with previously diagnosed epilepsy were excluded. Results: A total of 200 patients were eligible for the study. Of these, 92 (46%) patients with first onset seizures had an abnormality or abnormalities on brain CT scan. Of those patients whose HIV status was known, 50% of HIV positive and 53% of HIV negative patients had abnormal CT scans. 54% of patients with focal seizures and 38% with generalised seizures had an abnormality on CT scan. Abnormalities found on CT scans included chronic cerebral infarction (7.5%), acute or subacute cerebral infarction (4.5%), neurocysticercosis (7.0%), other infections (6.5%), haemorrhage and other vascular lesions (6.5%), post-traumatic encephalomalacia (6.5%), primary brain tumours and metastases (based on CT characteristics) (7.0%). Conclusion: Forty-six (46%) of patients presenting to the Groote Schuur Hospital ED, Cape Town, South Africa with first onset seizures had an abnormality on their brain CT scans. Brain CT scan is therefore recommended in patients presenting to the ED department with first-onset seizures, irrespective of their HIV/ neurological status.
Networked Digital Library of Theses and Dissertations