CT brain findings and common co-morbid disease in patients presenting with first time seizures

Abstract

INTRODUCTION: A significant number of patients attend to the Emergency Department due to the occurrence of a seizure event3–5. Seizure events can constitute up to 1% of all emergency department (ED) visits, with a quarter of these first time seizures6. Neuroimaging is key in the evaluation of patients with first time seizures10, and due to wider availability and quick acquisition time, computed tomography (CT) is routinely utilised. The expense associated with radiological imaging is significant9 and places a burden on constrained healthcare rescources12. Moreover, there is high mortality associated with acute symptomatic seizures from CNS infections, stroke and traumatic brain injury2,7,13 , necessitating determination of the prevalence of these diseases. AIM: The aim of the study was determining the CT scan findings of patients presenting with first time seizures. METHOD: The study was a retrospective analysis of CT brain scans done in patients with first time seizures at Helen Joseph Hospital in Johannesburg, from January 2015 – December 2015. Associated co-morbid disease was also documented and analysed. RESULTS: About 313 CT brain scans were included in the study, with the average patient age being 44 years and 56% of the scans having abnormal findings. CNS infections (15% or 47 cases) were the most prevalent cause of radiological abnormality, followed by cerebrovascular accidents (CVA) (11% or 33 cases) and lastly Traumatic Brain Injury (TBI) (4% or 14 cases). The most prevalent co-morbid disease was retroviral disease (RVD), (27% of patients), hypertensive disease (16%) and acute head injury (10.5%). We also found a strong association between patient age and abnormal CT scan findings, with the average age of patients with abnormal scans being 49 years and those with normal scans 38 years (p-value: 0.001). Furthermore, we found that the older patients were likely to present with CVA or neoplastic brain disease, and that overall , the patients with CVA were on average 52 years old (p-value 0.001). CONCLUSIONS: We established that CNS infections were the most common finding in first time seizure patients and that underlying HIV infection was the most common associated co-morbid disease, thus firmly establishing the leading role of infectious disease in seizure presentation. CVA’s were the third most common radiological finding and co-morbid hypertension the second most common disease, reflecting the effect of non-communicable disease in the South African population. Lastly, despite the endemic prevalence of trauma in South Africa, traumatic brain injury did not feature as highly in the causes of first-time seizure presentation (6th overall). The 8% prevalence we found is within the 4-9% prevalence in most international studies3,6,29