Abstract
Background: Emergency neuroimaging of human immunodeficiency virus (HIV)-positive patients with generalised new onset seizures (NOS) and a normal post-ictal neurological examination remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology. The objectives of our study were to establish whether cranial computed tomography (CT) affects the emergency management of HIV-positive patients with generalised NOS and a normal post-ictal neurological examination.Method: We conducted a prospective descriptive observational study. Consecutive HIVpositive patients of 18 years and older, who presented to the Kimberley Hospital Complex’s Emergency Department within 24 hours of their first generalised seizures and who had undergone normal post-ictal neurological examinations, were included. Emergency CT results as well as CD4-count levels were evaluated.Results: A total of 25 HIV-positive patients were included in the study. The results of cranial CT brought about a change in emergency care management in 12% of patients, all of them with CD4 counts below 200 cells/mm3 .Conclusion: We suggest that emergency cranial CT be performed on all HIV-positive patients presenting with generalised NOS and a normal post-ictal neurological examination, particularly if the CD4 count is below 200 cells/mm3.Keywords: HIV; Seizures; CT Brain
Highlights
Emergency neuroimaging of new onset seizures (NOS) in patients infected with the human immunodeficiency virus (HIV) remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology.[1,2]
A total of 25 HIV-positive patients with generalised NOS and a normal post-ictal neurological examination were included in the study, of whom 15 (60%) patients were male and 10 (40%) were female; the median age was 40 years
The results of cranial computed tomography (CT) brought about a change in emergency care management in 12% of patients, which suggests that cranial CT has a role to play in the emergency management of the HIV-positive patient who presents with generalised NOS and a normal post-ictal neurological examination
Summary
Emergency neuroimaging of new onset seizures (NOS) in patients infected with the human immunodeficiency virus (HIV) remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology.[1,2]In our institution, which is a centre with a significant radiological burden (serving a population of 1.2 million people), we currently use the Kimberley Hospital Rule for urgent computed tomography (CT) of the brain in a resource-limited environment,[3] which includes emergency scanning of all patients with focal seizures. Emergency neuroimaging of new onset seizures (NOS) in patients infected with the human immunodeficiency virus (HIV) remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology.[1,2]. No clear guideline exists for HIV-infected patients presenting with generalised seizures and a normal post-ictal neurological examination, and it is an area requiring further investigation. Emergency neuroimaging of human immunodeficiency virus (HIV)-positive patients with generalised new onset seizures (NOS) and a normal post-ictal neurological examination remains controversial, with the general impression being that emergency imaging is necessary because immunosuppression may blur clinical indicators of acute intracranial pathology. The objectives of our study were to establish whether cranial computed tomography (CT) affects the emergency management of HIV-positive patients with generalised NOS and a normal post-ictal neurological examination
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