Cranial Computed Tomography Findings Research Articles

Prognostic role of serum copeptin levels in adults with graded traumatic brain injury.

The efficacy of copeptin in patients with severe head injuries remains unclear. To investigate the role of serum copeptin levels in detecting intracranial injury, assessing trauma severity, and predicting outcomes in adults with graded traumatic brain injury (TBI). This prospective non-randomized controlled study enrolled 78 adults with isolated head trauma, as well as 59 age- and sex-matched controls. Baseline serum copeptin levels were measured in both groups. Patients were categorized by head trauma severity using Glasgow Coma Scale (GCS) scores (severe GCS 3-8, moderate GCS 9-13, mild GCS 14-15) and by the presence of intracerebral or extracerebral lesions on cranial computed tomography (CCT). Patients were also classified as survivors or non-survivors. Serum copeptin levels were compared among these. Mean serum copeptin levels were significantly higher in patients with graded TBI than in controls. Furthermore, patients with severe and moderate head trauma had significantly higher copeptin levels compared with patients exhibiting mild trauma. An optimal copeptin cutoff value of > 1147pg/mL was identified, indicating the presence of moderate or severe trauma in TBI patients. Patients with abnormal CCT findings had significantly higher mean serum copeptin levels compared with patients exhibiting normal CCT scans. Non-survivors also showed significantly higher serum copeptin levels compared with survivors. Serum copeptin levels rise after graded TBI and can distinguish between patients with and without intracranial or extracranial lesions evident on CCT. Copeptin levels also aid in identifying moderate or severe TBI and in predicting 28-day mortality.

Continuous epileptiform discharges are associated with worse neurodevelopmental findings in a congenital Zika syndrome prospective cohort

PurposeThis study aimed to identify continuous epileptiform discharges (CEDs) on electroencephalograms (EEG) and to determine their clinical significance in children with congenital Zika syndrome (CZS). MethodsThis prospective cohort study included 75 children diagnosed with CZS born from March 2015 and followed up until September 2018 (age up to 36 months). EEG was performed to detect CEDs up to 24 months old. Data on obstetric, demographic, and clinical signs; cranial computed tomography (CT); ophthalmology examination; anti-seizure medication; growth; and motor development were collected. Fisher's exact test was used to verify the associations between categorical variables, and the T- test was used to compare the mean z-scores of anthropometric measurements between the groups with and without CED. ResultsCEDs were identified in 41 (54.67 %) children. The mean age of CEDs identification was 12.24 ± 6.86 months. Bilateral CEDs were shown in 62.89 % of EEGs. CEDs were associated with severe congenital microcephaly, defined by z-score >3 standard deviation of head circumference (HC) below the mean for sex and age (p = 0.025), and worse outcomes, including first seizure before 6 months (p = 0.004), drug-resistant epilepsy (p < 0.001), chorioretinal scarring or mottling (p = 0.002), and severe CT findings (p = 0.002). The CED group had lower mean z-scores of HC up to 24 months of age. ConclusionThis is the first description of the prevalence and significance of CEDs that also remains during wakefulness in patients with CZS. New investigations may suggest that it is more appropriate to classify the EEG not as a CED, but as a periodic pattern. Anyway, CEDs may be a marker of neurological severity in children with CSZ.

Correlation between early computed tomography findings and neurological outcome in pediatric traumatic brain injury patients

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Head computed tomography (CT) is frequently utilized for evaluating trauma-related characteristics, selecting treatment options, and monitoring complications in the early stages. This study assessed the relationship between cranial CT findings and early and late neurological outcomes in pediatric TBI patients admitted to the pediatric intensive care unit (PICU). The study included children aged 1 month to 18 years who were admitted to the PICU due to TBI between 2014 and 2020. Sociodemographic data, clinical characteristics, and cranial CT findings were analyzed. Patients were categorized based on their Glasgow Coma Scale (GCS) score. Of the 129 patients, 83 (64%) were male, and 46 (36%) were female, with a mean age of 6.8 years. Falls (n = 51, 39.5%) and in-vehicle traffic accidents (n = 35, 27.1%) were the most common trauma types observed. Normal brain imaging findings were found in 62.7% of the patients, while 37.3% exhibited intracranial pathology. Hemorrhage was the most frequent CT finding. Severe TBI (n = 26, p = 0.032) and mortality (n = 9, p = 0.017) were more prevalent in traffic accidents. The overall mortality rate in the study population was 10.1%. In children with TBI, cranial CT imaging serves as an essential initial method for patients with neurological manifestations. Particularly, a GCS score of ≤ 8, multiple hemorrhages, diffuse cerebral edema, and intraventricular bleeding are associated with sequelae and mortality.

Is Cranial Imaging Necessary in Children with First-Time Focal Seizures?

Objective: Seizures in children represent a common cause of admission to the emergency department. This study aimed to determine clinically significant intracranial abnormalities in children presenting to the pediatric emergency department with first-time focal seizures.&#x0D; Methods: Patients aged 1 month-18 years, who presented to the pediatric emergency department with first-time focal seizures between 2009 and 2019, were retrospectively screened. Patients with a history of trauma, cases in which focal neurological signs could not be assessed, and patients with pre-existing structural brain or neurological abnormalities, and metabolic disorders were excluded from the study. Cranial computed tomography findings were re-evaluated by a pediatric radiologist. The fourth and fifth-level according to the classification of the International League Against Epilepsy were interpreted as urgent intracranial pathologies requiring medical or surgical intervention. The univariate analysis was performed using the chi-square test for categorical data and the Mann-Whitney U test for continuous data.&#x0D; Results: The mean age of the 121 patients was 46.8±44.4 months, and 52.9% were male. Clinically significant emergency intracranial pathologies were detected in the neuroimaging of eight patients. Intracranial masses, bleeding, and hematomas were the most common pathologies. The presence of focal neurologic findings and an age below six months were clinically determined as predictors of an urgent intracranial pathology.&#x0D; Conclusion: We found the rate of urgent cranial pathologies to be 6.6% in patients presenting to the emergency department following the first focal seizure. Children younger than six months with focal neurological signs should be evaluated for emergency neuroimaging.

The Child with a Large Head: Cranial Computed Tomography Findings in 123 Nigerian Children with Macrocephaly

Objectives: Differentiation of benign macrocephaly from other etiologies that may require prompt evaluation and intervention is very necessary to prevent long term neurological deficits. Cross-sectional imaging of the brain with Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) is recommended in evaluation of such patients. In resource poor-settings, CT is more readily available, hence the objective in this study is to evaluate the spectrum of CT findings in children with macrocephaly in our locality and document the possible etiologic factors that are amenable to surgical intervention.&#x0D; Materials and Methods: This is a retrospective study of pediatric patients with clinical diagnosis of large head/macrocephaly who were evaluated with cranial CT in a tertiary hospital in Abuja from January 2018- June 2022. SAS software (SAS Institute, Cary, North Carolina, USA) version 9.4 was used for database management and analysis with P≤ 0.05 level of significance.&#x0D; Results: One hundred and twenty three children were included in the study with ages ranging from 2 days to 4 years. Majority of the children were males, 74 (60.2%). The predominant age group at presentation was between 0 to 6 months,78 (63.4%). Hydrocephalus was the main cause of macrocephaly in 110 patients (89.4%). Congenital hydrocephalus was predominant in 81 children (73.6%). Communicating hydrocephalus was noted in 44 children (40%) while 62 (56.4%) were non-communicating. The commonest level of obstruction was at the aqueduct of Sylvius and exit foramina in 22 (35.5%) patients each. There was no significant statistical difference between the genders(P=0.920).&#x0D; Conclusion: CT is a veritable tool in the evaluation of the child with a large head with an appreciable number of surgically amenable pathologies noted. Hydrocephalus is the commonest etiology of macrocephaly in our environment with the majority of the cases due to congenital abnormalities.

Computerized Tomographic Brain Findings in Hypertensives with Stroke in Abuja, Nigeria

Abstract Background: Stroke has become an increasingly significant health problem, and early diagnosis of the stroke type with prompt management improves prognosis. Neuroimaging is crucial to the management of stroke, and computed tomography (CT) scan is a cardinal diagnostic tool in identifying the subtypes, the knowledge of which will improve the management of the patients. Aims and Objectives: The study was aimed at establishing the cranial CT findings in hypertensives with stroke, ascertain the type of stroke, frequency of specific features, such as sites, vascular territories, and secondary effects of the primary lesion. Associations of CT findings with variables such as age and coexisting risk factors were also explored. Materials and Methods: Eighty-four adult hypertensive patients with clinical diagnosis of stroke were serially recruited and cranial CT scan was performed, using 16-slice multidetector CT machine (Toshiba Activion 16®), within 24 h of presentation at the emergency department. All clinical findings, demographic parameters, and radiological findings were documented. The data obtained were analyzed using the Statistical Package for Social Sciences (IBM SPSS version 23.0. Armonk, NY, USA). Results: The mean age of the patients was 57.94 ± 12.05 (mean ± standard deviation) and females were more than males with a male:female ratio of 1:1.3. Ischemic stroke constituted 59.5% while hemorrhagic stroke was 40.5%, and the left middle cerebral artery territory was the most common area affected by both stroke types (P &lt; 0.01). Most of the intracerebral bleed occurred in the basal ganglia (50%), and hemorrhagic stroke was more associated with severe neurological deficits (67.6%) (P &lt; 0.001). Conclusion: Ischemic stroke was more common than hemorrhagic stroke, and more women were affected on a general note. The middle cerebral artery territory is the most common site of affectation, and positive association was established between noncompliance with anti-hypertensive medication and stroke.

Relevance and challenges of neuroimaging for childhood tuberculous meningitis diagnosis in a resource-constraint country: A case report and literature review

Objective: Tuberculous meningitis (TBM) may be an undiagnosed cause of childhood mortality or neurologic sequelae. Cranial computed tomography (CT) scan remains a relevant diagnostic and prognostic tool amidst negative cerebrospinal fluid or sputum findings for tuberculous meningitis (TBM) diagnosis. Delays in diagnosis and treatment increase morbidity in resource-constraint countries.&#x0D; Case report: A seven-year-old boy was referred with three weeks history of fever, progressive body weakness, aphasia and unconsciousness (three days). He had right cranial nerve III palsy, generalized hypertonia, and hyperreflexia in right lower limbs. All tuberculosis tests were negative except the cranial CT findings of leptomeningeal enhancement with basilar involvement and evidence of obstructive hydrocephalus. He was managed with anti-tuberculous drugs, prednisolone, ventriculoperitoneal shunt, and physiotherapy, and made a significant recovery after a year of anti-tuberculosis treatment.&#x0D; Conclusion: The cranial CT scan findings facilitate TBM diagnosis for which prompt treatment commencement is crucial for a good outcome.

A prospective observational study on evaluating the efficacy of bedside optic nerve sheath diameter in assessing clinical progression of patients admitted in neurosurgical ICU with comparisons to CT scans and GCS score

Background: Ultrasound of the optic nerve sheath diameter (ONSD) is a non-invasive, repeatable tool that can be used to measure intracranial pressure in a dynamic way with high diagnostic accuracy. The goal of this study was to find out if a bedside ultrasonographic measurement of optic nerve sheath diameter (ONSD) can accurately predict the computed tomography (CT) findings of high intracranial pressure (ICP) and changes to the Glasgow Coma Scale (GCS) in adult head injury patients in the Neurosurgery ICU. Methods: For 54 patients in the neurosurgical intensive care unit, we conducted a retrospective analysis of the results of cranial ultrasounds. Those under the age of 18 and those with apparent visual injuries were ineligible. Both horizontal and vertical optic nerve sheath diameters were measured 3 mm beneath the globe in each eye using a 7.5-10MHz ultrasonographic probe. A binocular change in optic nerve sheath diameter of more than 2.00 mm was deemed abnormal in two consecutive readings in the same patient. Patients in the neurosurgical ICU were given a GCS score, which was used to classify their level of brain damage as mild, moderate, or severe. The accuracy of the optic nerve sheath diameter was evaluated using cranial CT findings of shift, oedema, or effacement that suggested an increased intracranial pressure. Results: The research has 54 participants. According to the results, 68.5% of those who took the study were men, while 31.5% of those who did so were women. Nearly 16.7 per cent of respondents were between the ages of 18 and 40, while 40.7% of respondents were between the ages of 40 and 60, and 42.6% of respondents were above 60. The significant change in ONSD- fall in GCS and CT-progression scan-findings correlation was very strong. When compared to CT scan progression, the ONSD bedside sonographic test had an 86.7% sensitivity and an 89.7% specificity for detecting elevated ICP. The Positive Predictive Value of the reduction in GCS with advancement in CT scan was 80% and the Negative Predictive Value was 89.7%, respectively. Conclusions: The sensitivity, specificity, and positive predictive value of bedside ONSD ultrasonography in predicting high intracranial pressure are significant to those of progression in CT scan and drop in GCS. An ONSD bedside measurement may be used to determine elevated ICP since it is non-invasive and repeatable.

CT dose management for neurologic events in patients with cardiac devices: Radiation exposure variation in patients with cardiac devices.

To compare the inter-center cranial computed tomography (CT) acquisition rates, CT findings, CT related radiation dose, and variability of CT acquisition parameters for neurologic events among patients with implantable cardioverter-defibrillator (ICD) or left ventricular assist device (LVAD). A total of 224 patients [ICD group (n = 155) and LVAD group (n = 69)] who had at least one cranial CT scan were enrolled from three medical centers. The variability and effect of the number, indication, and findings of cranial CT scans as well as CT acquisition parameters including tube potential, tube current, tube rotation time (TI), slice collimation (cSL), and spiral or sequential scanning techniques on CT dose index volume (CTDIvol), total dose length product (DLP) were analyzed. The mean DLP value of Center A and mean CTDIvol values of Center A and C were significantly lower than Center B (p < 0.001). The mean CTDIvol and DLP values in the ICD group were substantially lower than the LVAD group (p<0.001). The most potent parameters causing the changes in CTDIvol and DLP were kV, mAs values, and CT scanning technique as sequential or spiral according to multivariate linear regression analysis. Cranial CT acquisition parameters and radiation doses vary significantly between centers, which necessitates optimization of cranial CT protocols to overcome the cumulative radiation dose burden in patients with neurologic events.

Assessment of the orbital structures using computed tomography in healthy adults.

In this study, we retrospectively evaluated the orbital and ocular dimensions using computed tomography (CT) scans in healthy adults. This retrospective study included 302 Turkish adult individuals aged 20-76 years (158 males and 144 females), who underwent paranasal sinus or craniofacial CT due to headache or suspicion of sinusitis, but abnormal orbital or cranial CT findings were not detected. Linear and volumetric measurements of the orbital structures were performed in the sagittal, coronal, and axial planes on CT slices. The volume was estimated in cubic centimeters using the equation of the ellipsoid method. A total of 34 parameters were measured from both eyes of each individual using 14 different anatomical landmarks and analyzed by gender and age. Parameter values of orbital structures in males and females are shown in millimeters or cubic centimeters. In most of the 34 parameters that we evaluated, it was seen that males had statistically significant higher mean values than females (P < 0.05). Also, there was no statistically significant difference between the measurements of right and left orbits. The correlation with age was varied according to the 34 parameters. Interestingly enough, there were no statistically significant differences between the two genders for extraocular muscles thickness (except superior muscles group thickness-SMT) and left optic nerve thickness (LOT) (p > 0.05). The mean right superior muscles group thickness was 5.35 ± 0.85 mm in the male subjects and 4.64 ± 1.10 mm in the female subjects (P < 0.001). The mean left superior muscles group thickness (LSMT) was 5.28 ± 0.88 mm in the male subjects and 4.67 ± 1.16 mm in the female subjects (P < 0.001). The mean LOT was 6.15 ± 0.97 and 5.88 ± 1.07 mm in males and females, respectively (P = 0.099). This study can be applied to the standardization of orbital morphometry in healthy adults.

The degree and appropriateness of computed tomography utilization for diagnosis of headaches in Ghana

IntroductionHeadache is a common and sometimes debilitating medical condition. Patients presenting with no neurologic anomaly, nontraumatic primary headache require careful evaluation before neuroimaging. National Guidelines standardizing exploitation of Computed Tomography (CT), the most utilized imaging modality in this clinical scenario, has not been established in Ghana, a developing country with limited healthcare resources. The country has not also adopted existing guidelines such as the National Institute for Health and Care Excellence (NICE) of the United Kingdom or the Appropriateness Criteria (AC) of the American College of Radiologists (ACR). The purpose of this review was to analyze the propensity of CT utilization for diagnosing headaches against the AC of the ACR and discuss some of the socio-economic inferences thereof. MethodsThis study retrospectively reviewed CT imaging records and clinical data of all patients referred for head CT scans between 1st January 2016 and 31st December 2018 at five major health facilities (four tertiary government hospitals and one private hospital) across Ghana. We isolated all head CT scans performed for the diagnosis of headache for analysis. We analyzed the type of presenting headache, CT findings, gender distribution, pattern of referrals, and head CT appropriateness against the AC of the ACR. ResultsA total of 44,218 patients were referred to the five facilities for head CT secondary to diverse indications for the period. All non-trauma cases were 41.7%; trauma cases were 31.6%, the majority (72.3%) were from road traffic accidents. The majority (64.9%) of trauma casualties were males. A total of 11,806 (26.7%) patients were referred for a head CT scan for the diagnosis of headache. The private hospital recorded the highest referrals for head CT scan for diagnosis of headache. The gender distribution of all headache patients was 57.6% females, and 42.4% were males. The age distribution showed 19.3% were children, 71.2% were adults, and the aged constituted 9.4%. The results showed 2.8% significant cranial CT findings of all reviewed headache patients. Pathological findings among the cohort of children were 0.6%.The sources and pattern of referrals showed 57.3% were from the Outpatient Department, 26.6% from the Emergency Department, in-patients’ referrals were 9.4%, and specialist consultation was 7.1%. Analysis of CT scans performed against the AC of the ACR, showed 69.0% of headache patients were likely scanned inappropriately. ConclusionsThere is a need to implement international best practice guidelines or develop a national neuroimaging policy to protect patients. Unjustified CT utilization for diagnosis of headaches exposes patients to unnecessary ionizing radiation that can instigate cancer and unnecessary expenditure. Head CT scan for some headache patients with normal neurologic findings may be unnecessary in an emerging country like Ghana. Clinicians must, therefore, be discerning in CT scan requests for the diagnosis of headache.

Intracranial pressure monitoring following traumatic brain injury: evaluation of indications, complications, and significance of follow-up imaging\u2014an exploratory, retrospective study of consecutive patients at a level I trauma center

BackgroundMeasurement of intracranial pressure (ICP) is an essential part of clinical management of severe traumatic brain injury (TBI). However, clinical utility and impact on clinical outcome of ICP monitoring remain controversial. Follow-up imaging using cranial computed tomography (CCT) is commonly performed in these patients. This retrospective cohort study reports on complication rates of ICP measurement in severe TBI patients, as well as on findings and clinical consequences of follow-up CCT.MethodsWe performed a retrospective clinical chart review of severe TBI patients with invasive ICP measurement treated at an urban level I trauma center between January 2007 and September 2017.ResultsClinical records of 213 patients were analyzed. The mean Glasgow Coma Scale (GCS) on admission was 6 with an intra-hospital mortality of 20.7%. Overall, complications in 12 patients (5.6%) related to the invasive ICP-measurement were recorded of which 5 necessitated surgical intervention. Follow-up CCT scans were performed in 192 patients (89.7%). Indications for follow-up CCTs included routine imaging without clinical deterioration (n = 137, 64.3%), and increased ICP values and/or clinical deterioration (n = 55, 25.8%). Follow-up imaging based on clinical deterioration and increased ICP values were associated with significantly increased likelihoods of worsening of CCT findings compared to routinely performed CCT scans with an odds ratio of 5.524 (95% CI 1.625–18.773) and 6.977 (95% CI 3.262–14.926), respectively. Readings of follow-up CCT imaging resulted in subsequent surgical intervention in six patients (3.1%).ConclusionsInvasive ICP-monitoring in severe TBI patients was safe in our study population with an acceptable complication rate. We found a high number of follow-up CCT. Our results indicate that CCT imaging in patients with invasive ICP monitoring should only be considered in patients with elevated ICP values and/or clinical deterioration.

Evolution of paediatric head trauma patients with CT; The requirement of computed tomography in children with head injury: a cross-sectional study

INTRODUCTION: In this study, we aimed to reveal the cranial computed tomography (CT) results of paediatric head trauma cases taken in our hospital and what clinical variables might be related to pathology in cranial CT. MATERIAL AND METHODS: Age, gender, glasgow coma scale (GCS), open or suspicious skull fracture, vomiting≥ 2, retrograde amnesia ≥ 30 minutes, the detailed mechanism of injury and CT findings (if CT is available)were evaluated. RESULTS: 66 of the cases were female (35.7%) and 119 were male (64.7%). The ages of the patients vary between 0 and 16 and the average age is 6.76. 108 (58.4%) of the patients had admitted to the hospital with traumas resulted from falling. 33 (17.8%) of them were passengers of a four-wheeled vehicle and 15 (8.1%) were had been crashed with a four-wheeled vehicle. CONCLUSIONS: In paediatric head traumas, falls and traffic accidents are in the first place and the measures taken in this regard should be increased.

Cranial computed tomography imaging of patients with stroke in a tertiary facility

Background: Neuroimaging plays an important role in stroke management by providing information to accurately triage patients, expedite clinical decision with regard to treatment, and in improving outcomes in patients presenting with stroke. The aim of this study is to determine the spectrum of computed tomography (CT) findings in patients with stroke with respect to the type of lesion, location, and possible risk factors. Materials and Methods: This was a retrospective study with data compiled from medical files and cranial CT scan images of 148 patients clinically diagnosed with stroke conducted over a period of 36 months from the Department of Radiology, University of Abuja Teaching Hospital. Results: There were 148 patients with complete data who were clinically diagnosed with stroke. From cranial CT findings, 56.1% of patients studied had cerebral infarct, 41.2% hemorrhage, and 2.7% normal findings. The gender distribution of cranial CT findings was not statistically significant (P = 0.09 for males andP = 0.07 for females). The parietal lobe was the most affected site for hemorrhage and infarcts accounting for 31.1% and 49.4%, respectively. The cerebellum was the least affected site. The two most commonly documented risk factors identified in this study were hypertension and diabetes mellitus accounting for 61.9%. Conclusion: Cerebral infarct was the most common computed tomographic finding among patients with stroke, and the parietal lobe was the most common location for infarct and hemorrhage. Hypertension was a major risk factor for stroke. CT is an important imaging modality for diagnosis, differentiating infarct from hemorrhage in stroke management.

Non-contrast Cranial Computed Tomography can Change the Emergency Management of Nontraumatic Seizure Patients

Objective: The abnormal cranial computed tomography (CT) findings can change the emergency management in 9 - 17% of first seizure patients in the emergency department (ED). The aim is to evaluate the utility of non-contrast cranial CT on emergency management of non-traumatic ED seizure patients. Methods: The patients’ charts, who had been coded G-40 according to ICD-10, between 2013 and 2015 were reviewed. All adult patients who applied to the ED with epileptic activity were included. The patients who had trauma, inefficacy in medical record and absence of CT report and detected as not to have seizure were excluded. The socio-demographic and seizure characteristics, CT indications and interpretations and emergency outcomes of patients were investigated. Data were pointed out as numbers, percentages and mean ± standard deviations. Pearson and Fisher’s chi-square tests were used for evaluating of categorical variables. p value < 0.05 was accepted as significant. Results: 814 patients were included. 55.7% were male. Mean age was 50 years (50.50 ± 20.26 years, 95% CI). 56.5% had chronic and 43.5% had first seizure activity. New abnormal CT findings were detected in 33.9% of first and in 11.7% of chronic seizure patients. Total abnormal CT findings ratio was 52%. 14.7% of first seizure and 7.2% of chronic seizure patients’ emergency managements were changed due to abnormal CT findings. Totally, 10.4% of all patients’ emergency management was detected as changed. Conclusions: In the ED, either in first or in chronic seizure activity, non-contrast cranial CT scan is a practice that may change the patients’ emergency managements.

Correlation between optic nerve sheath diameter and Rotterdam computer tomography scoring in pediatric brain injury.

Pediatric head trauma is the most common presentation to emergency departments. Increased intracranial pressure (ICP) may lead to secondary brain damage in head trauma and early diagnosis of increased ICP is very important. Measurement of optic nerve sheath diameter (ONSD) is a method that can be used for determining increased ICP. In this study, we aimed to evaluate the relationship between optic nerve sheath diameter (ONSD) and Rotterdam computer tomography scores (RCTS) in pediatric patients for severe head trauma. During January 2017-April 2018, medical records and imaging findings of children aged 0-18 years who underwent computed tomography (CT) imaging for head trauma (n=401) and non-traumatic (convulsions, respiratory disorders, headache) (n=255) complaints, totally 656 patient were evaluated retrospectively. Patients' age, sex, presentation and trauma type (high energy-low energy) were identified. Non-traumatic patients with normal cranial CT findings were considered as the control group. CT findings of traumatic brain injury were scored according to Rotterdam criteria. Patients were divided into groups according to their age as follows: 0-3 years, 3-6 years, 6-12 years and 12-18 years. In our study, tomographic reference measurements of the ONSD in pediatric cases were presented according to age. There was a statistically significant difference between ONSD of severe traumatic patients and the control group. Correlation between RCTS and ONSD was determined and age-specific cut-off values of ONSD for severe traumatic scores (score 4-5-6) were presented. In our study, reference ONSDs of the pediatric population for CT imaging was indicated. Our study also showed that ONSD measurement is a parameter that can be used in addition to the RCTS to determine the prognosis of the patient in severe head trauma, by reflecting increased intracranial pressure.

A new clinical score for cranial CT in ED non-trauma patients: Definition and first validation

IntroductionWell recognized guidelines are available for the use of cranial computed tomography (CCT) in traumatic patients, while no definitely accepted standards exists to for CCT in patients without history of head injury. The aim of this study is to propose an easy clinical score to stratify the need of CCT in emergency department (ED) patients with suspect non-traumatic intracranial pathology. MethodsWe retrospectively evaluated patients presenting to the ED for neurological deficit, postural instability, acute headache, altered mental status, seizures, confusion, dizziness, vertigo, syncope, and pre-syncope. We build a score for positive CCT prediction by using a logistic regression model on clinical factors significant at univariate analysis. The score was validated on a population of prospectively observed patients. ResultsWe reviewed clinical data of 1156 patients; positivity of CCT was 15.2%. Persistent neurological deficit, new onset acute headache, seizures and/or altered state of consciousness, and transient neurological disorders were independent predictors of positive CCT. We observed 508 patients in a validation prospective cohort; CCT was positive in 11.3%. Our score performed well in validation population with a ROC AUC of 0.787 (CI 95% 0.748–0.822). Avoiding CT in score 0 patients would have saved 82 (16.2%) exams. No patients with score 0 had a positive CCT findings; score sensitivity was 100.0 (CI 95% 93.7–100.0). ConclusionsA score for risk stratification of patients with suspect of intra-cranial pathology could reduce CT request in ED, avoiding a significant number of CCT while minimizing the risk of missing positive results.

Review of adult head injury admissions into the intensive care unit of a tertiary hospital in Nigeria

Background: Head injury is frequently associated with death and disability and imposes considerable demands on health services. Outcome after head injury is closely related to prompt management, including prevention of secondary brain injury and intensive care unit (ICU) management. This study aimed at determining the aetiological spectrum, injury characteristics, ICU admission patterns, and treatment outcomes of adult head-injured patients at a sub-Saharan tertiary hospital. Methods: A retrospective study on adult head-injured patients admitted to the ICU of a sub-Saharan tertiary hospital between July 2000 and June 2010. Results: A total of 198 head-injured adult patients were managed in the ICU during the study period. This included 128 males and 70 females with a male-to-female ratio of 1.8:1. The most common mode of injury was road traffic accident. All the patients admitted to ICU had either moderate or severe head injury, with 73.7% having severe head injury. About 26.3% of the patients had associated cervical spine injuries and 50% had various musculoskeletal and soft tissue injuries. Cranial computed tomography findings included brain contusions and intracranial haematomas. Mean duration of ICU stay was 18 days (range 24 hours-42 days), with 89.9% discharged out of ICU care. The overall mortality was 10.1%, although only 36.9% had satisfactory outcomes, as determined by the Glasgow Outcome Scale. Outcome had statistically significant (P < 0.05) relationship with severity of head injury and surgical intervention. Conclusions: Head injury management in the ICU requires an approach to ensure prevention of secondary brain injury; appropriate and early neuroimaging to diagnose lesions that would benefit from timely surgical intervention; as well as management of fluid, electrolyte and haematological derangements. Keywords: head injury; admissions; ICU

Indications for cranial computed tomography scan in ophthalmology: Experience at a tertiary hospital in Southern Nigeria

Objectives: The aim of this article is to determine the common indications for cranial computed tomography (CT) scanning in ophthalmology at the University of Benin Teaching Hospital Nigeria and to compare the CT findings with the clinical indication. Materials and Methods: A retrospective analysis of CT imaging requisitions from the Department of Ophthalmology to the Department of Radiology of the hospital from February 2009 to October 2013 was performed. Data on age, gender, clinical symptoms, clinical signs, diagnosis, and the radiologic findings were retrieved and analyzed using IBM Statistical Package for the Social Sciences version 21. Descriptive analyses were used and Fisher’s exact test was used as a test of statistical significance. Results: A total of 112 patients were included in the study. There were 48 males and 64 females. The mean age was 33 ± 19.1 years (range 5 months–82 years). Visual loss 36 (32.1%), proptosis 25 (22.3%), and headache 22 (19.6%) were the most common symptoms documented, whereas optic atrophy 16 (14.3%), optic disc swelling nine (8%), and proptosis nine (8%) were the most common signs. The CT finding was related to the clinical information in 67 (59.8%) cases. Conclusion: CT is a useful tool in the evaluation of orbital and neuro-ophthalmic diseases. It aids in the diagnosis and localization of lesions in ophthalmology.

Computed tomography findings in pediatric traumatic head injury in Abuja, Nigeria

Background: Pediatric traumatic brain injury (TBI) remains one of the leading causes of acquired disability and death in children. The morbidity and mortality associated with significant intracranial injury may be ameliorated by early diagnosis and treatment. Cranial computed tomography (CT) is a reliable imaging method for identification of intracranial lesions in patients with head trauma. Aim: To document the radiologic features of cranial CT in pediatric head trauma patients in a Tertiary Hospital in Abuja, Nigeria. Method: This was a retrospective, cross-sectional study of cranial CT findings in 104 pediatric head trauma patients visiting a tertiary referral hospital in Abuja Nigeria from January 2014 to January 2017. Numerical and graphical descriptors were used to summarize the data. In all statistical tests, significance level was set at an alpha level of 0.05. Result: Ages of studied patients ranged from 3 months to 18 years with mean age of 9.7 (SD 5.4) years with males dominating (66.35%). Road traffic accident, RTA occurred in 82 (79.6%) as the commonest etiologic factor across all age groups with slight dominance in children older than 16 years. Radiologic abnormalities were seen in 89 (85.6%), especially in males. Fractures coexisting with intracranial lesions were the most prevalent findings occurring in 43 (41.3%) patients. Hemorrhagic contusion was the commonest intracranial pathology. Diffuse brain lesions were seen exclusively in patients with clinically severe brain injury. Conclusion: RTA is the commonest etiology of pediatric TBI in our environment with combined fractures and coexisting intracranial hemorrhages as the prevalent finding.