Original Research

An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa

Sabelo H. Mabaso, Deepa Bhana-Nathoo, Susan Lucas
South African Journal of Radiology | Vol 26, No 1 | a2294 | DOI: https://doi.org/10.4102/sajr.v26i1.2294 | © 2022 Sabelo H. Mabaso, Deepa Bhana-Nathoo, Susan Lucas | This work is licensed under CC Attribution 4.0
Submitted: 05 September 2021 | Published: 20 January 2022

About the author(s)

Sabelo H. Mabaso, Department of Radiology, Faculty of Health Sciences, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
Deepa Bhana-Nathoo, Department of Radiology, Faculty of Health Sciences, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
Susan Lucas, Department of Radiology, Faculty of Health Sciences, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa


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Abstract

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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