Original Research

The prevalence of abnormal findings in screening CT brains performed on patients admitted with psychiatric symptoms

Praniel Bennimahadeo, Jaynund Maharajh
South African Journal of Radiology | Vol 20, No 1 | a976 | DOI: https://doi.org/10.4102/sajr.v20i1.976 | © 2016 Praniel Bennimahadeo, Jaynund Maharajh | This work is licensed under CC Attribution 4.0
Submitted: 10 January 2016 | Published: 22 November 2016

About the author(s)

Praniel Bennimahadeo, Department of Radiology, King Edward VIII Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
Jaynund Maharajh, Department of Radiology, King Edward VIII Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa


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Abstract

Background: No clear guidelines exist regarding the role of computerised tomography (CT) as a screening neuroimaging tool in psychiatric practice. The aim of this study was to evaluate the usefulness of historical and clinical parameters on the CT request form, identify the spectrum of CT findings and correlate these to develop guidelines for the use of screening CT brains in patients who present with psychiatric symptoms.

Methods: Requests and reports for the brain CT’s of 507 consecutive patients over a 2-year period, between 2013 and 2014, referred from a psychiatric institute for screening CT brain scans, were reviewed. Analysis was performed for the history of trauma and seizures, Glasgow Coma Scale (GCS) score, focal neurological signs, papilloedema, electroencephalograph, relevant blood results and abnormal CT findings. All reports were approved by a consultant radiologist.

Results: No abnormality was noted in 69% of CT scans. Cerebral atrophy, infarcts, cysts and calcific foci were present in 30% of patients. One patient presenting with focal neurology had a CT demonstrating an extradural haematoma which required neurosurgical intervention. No focal brain lesions, potentially responsible for the psychosis, were identified in any other patient.

Conclusion: Routine CT screening of patients who present with psychotic symptoms, in the absence of focal neurological deficit, does not add value to patient outcome, but rather contributes to the escalating health care expenses and unnecessary radiation dose. CT screening of psychiatric patients should be reserved for patients with reliable predictors of intracranial abnormalities such as lateralising signs, seizures, persistent or worsening headaches; decrease in GCS, papilloedema and in patients where the onset of symptoms occurred at an age above 50.


Keywords

adult psychiatric neuroimaging; screening brain computed tomography; psychiatric patients; neuroradiology

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Crossref Citations

1. How often does computed tomography (CT) of the brain demonstrate a cause for psychosis? A 7-year retrospective study at a tertiary metropolitan hospital
Guy Harris, Hao Xiang, Irene Tan, Varundeep Randhawa
Australasian Psychiatry  vol: 27  issue: 2  first page: 183  year: 2019  
doi: 10.1177/1039856218815761