Computed Tomography of the Brain in Adults with First Seizure

Abstract

Seizure is frequently encountered in emergency department. Whether a neuroimaging should be done in every patient after a first seizure is controversial. Some study recommend imaging of brain usually with CT scan as a part of diagnostic investigation for every adult after a first seizure, while some prefer to reserve for patients with increased risk of intracranial pathology. This study has been undertaken to evaluate the role of routine CT scan of the brain in adult patients presenting with first episode of seizure in western development region of Nepal thus helping in management. This study also highlights the common CT abnormalities in patients presenting with seizure in western region of Nepal. This study was conducted in Radiology department of Manipal Teaching Hospital from August 2014 to June 2015. Patients of age > 16 years referred to our department for CT scan of head with history of first episode of seizure were included for study. Total 445 patients were included in study. Patients with history of previous seizure, head injury, electrolyte abnormalities, alcohol/drug intoxication were excluded from study. The mean age in our series was 33.75 years. There were 57.8 % males and 42.2 % were female. Focal seizure was seen in 54.8 % of patients whereas generalized seizure was seen in 45.2 % of patients. Abnormal CT scan was found in 60.7% of patients with first episode of seizure. CT scan was abnormal in 89.3 % of patients with focal seizure. Only 25.9 % of patients with generalized seizure had abnormal CT scan. Neurocysticercosis was the commonest abnormality detected on CT scan which was found in 36.85 % of patients. NCC was the commonest abnormality detected in younger population (46.1%) while infarct was common in older patients found in 21.3% of patients.