Abstract

MABASO, Sabelo H.; BHANA-NATHOO, Deepa  and  LUCAS, Susan. An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa. S. Afr. J. radiol. (Online) [online]. 2022, vol.26, n.1, pp.1-7. ISSN 2078-6778.  http://dx.doi.org/10.4102/sajr.v26i1.2294.

BACKGROUND: Globally, adults presenting with seizures account for 1% - 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. OBJECTIVES: To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. METHOD: A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. RESULTS: The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. CONCLUSION: A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24-48 h in a resource restricted setting.

Keywords : new-onset; first-onset; adult-onset; seizure; CT findings.

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