|Year : 2020 | Volume
| Issue : 2 | Page : 79-83
Adult brain computed tomography pattern among seizure patients in Kaduna: A 24-month review of findings
Tokan Silas Baduku, Abdulkadir Musa Tabari
Department of Radiology, Faculty of Clinical Sciences, College of Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria
|Date of Submission||26-Jun-2020|
|Date of Decision||13-Jul-2020|
|Date of Acceptance||16-Aug-2020|
|Date of Web Publication||30-Nov-2020|
Tokan Silas Baduku
Department of Radiology, Faculty of Clinical Sciences, College of Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna
Source of Support: None, Conflict of Interest: None
Background: Seizures are intracranial neuronal disorders that are observed globally but often poorly investigated and managed in developing countries. The advent of modern diagnostic tools, such as computed tomography (CT) and magnetic resonance imaging, is highly important in patient's workup toward diagnoses and subsequent management. Aim: The aim of this article is to evaluate the pattern of brain CT findings in adult patients presenting with seizure disorders in Kaduna and its environs. Materials and Methods: This is a 24-month retrospective and descriptive study carried out on 81 patients who presented between January 2017 and December 2018 at the Department of Radiology, National Ear Care Centre (NECC), Kaduna. Most of these patients with seizure disorders were normally referred to this center from within the state and from the neighboring states, and only those who satisfied the study criteria were included. Results: A total of 81 cases were reviewed (representing 8.4% of brain scans in NECC within the period of study). Males dominated with 64.2%, while those within the 20–29 years of age group constituted the highest number of patients who presented with seizures (30.9%). Imaging findings were normal in 26.7% of the patients. Conclusion: This shows the male preponderance of adult with seizures, with those in the third decade of life most affected. Headache and hemiparesis are the most common presenting complaints. In our environment, headache was the highest presenting symptom, followed closely by hemiparesis, while cerebral hypodensity was the most frequent finding.
Keywords: Adult patients, brain imaging pattern, computed tomography, seizures
|How to cite this article:|
Baduku TS, Tabari AM. Adult brain computed tomography pattern among seizure patients in Kaduna: A 24-month review of findings. J Radiat Med Trop 2020;1:79-83
|How to cite this URL:|
Baduku TS, Tabari AM. Adult brain computed tomography pattern among seizure patients in Kaduna: A 24-month review of findings. J Radiat Med Trop [serial online] 2020 [cited 2021 Aug 4];1:79-83. Available from: http://www.jrmt.org/text.asp?2020/1/2/79/301896
| Introduction|| |
Seizures are paroxysmal events due to abnormal excessive or synchronous neuronal activities in the brain., They are common neurologic conditions that affect approximately 50 million people worldwide, with about 80% found in lower socioeconomic groups of America and in developing countries., In the African continent alone, 10 million are affected by seizure. Modern structural and functional brain imaging modalities have created a significant impact on the diagnosis and management of all forms of seizures., However, seizures are often poorly investigated and managed in developing countries, with the reasons ranging from inadequate medical facilities, financial difficulties, to sociocultural factors., This results in insufficient evidence on the morbidity and mortality of epilepsy in the region, despite several epidemiological studies carried out in many Sub-Sahara African countries., The aim of this study is to determine the pattern of intracranial computed tomography (CT) pathologies in patients who presented with seizures in our environment and their possible etiologies.
| Materials and Methods|| |
This retrospective study was conducted on 81 patients in the Radiology Department of National Ear Care Centre, Kaduna, from January 2017 to December 2018, where a Toshiba Alexion 32 slice multidetector CT scanner was used. A multi-slice protocol with 3–8 mm (5 mm) cuts from the skull base to the vertex was used, and the images were acquired in the axial plane with multiplanar reformatted sagittal and coronal images which were generated. Majority of these patients with seizure disorders were from those referred. The inclusion criteria included patients of both sexes who are 20 years and above whose presenting symptom being seizure. The exclusion criteria included patients aged <20 years. Prior ethical clearance was obtained from the institution's research and ethical committee.
A retrospective analysis of their request forms and soft copy of CT images was reviewed independently by two consultant radiologists. In cases where they disagreed, they sat down together to come to an agreement. A pro forma was used to document the obtained information and the findings were documented. All data were entered, tabulated, and analyzed using the Statistical Package for the Social Sciences (SPSS 23, Armonk, NY, USA: IBM Corp). Frequency distributions (proportions), graphs, charts, and tables were drawn.
| Results|| |
Eighty-one adult patients with seizures who were in the age range of 20 years and above were reviewed within the 24-month period. Fifty-two (64.2%) patients of the study population were male and 29 (35.8%) were female (M:F = 1.8:1). The population distribution is shown in [Table 1]. The most affected age group was patients within the third decade of life (age range, 20–29), constituting 30.9% of the study population, while the least affected were the elderly who were 70 years and above, making up 4.9% of the population. All the patients under review presented with seizure disorders. However, 18 patients (19.1%) also had headache as an associated symptom either before or after seizures, followed closely by hemiparesis which was seen in 18.1% [Table 2]. Other associated symptoms are irrational behavior (16%), background history of trauma (13.8%), retroviral disease (11.7%), loss of consciousness (11.7%), and hypertension (9.6%). The least associated presenting symptom is those with background history of hypertension which was 9 (9.6%).
|Table 1: The demography of the patient based on age and sex distribution|
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For the imaging findings, more than a quarter (26.7%) of the patients showed normal brain scan, while 73.3% had one form of abnormality or the other. Among the abnormal findings, 25 patients showed effacement or dilatation of the lateral ventricles, which constituted 18.5% of the total population [Table 3] and [Figure 1]. Only one patient each showed a serpiginous vascular mass and arteriovenous malformation (0.7% each). Other findings, in order of frequency of occurrence, are cerebral hypodensity (18.5%), prominent sulci (12.6%), cerebral atrophy (8.2%), cerebral cystic (8.2%), solid (2.2%) and calcific masses (1.5%), dilated 3rd/4th ventricles, and eroded cranial floor. Other findings that include intracranial foreign bodies, sulci effacement, and cranial fracture constituted about 14.8%.
|Figure 1: Shows hypodense frontal areas bilaterally. There are also hypodense cerebral areas in the right parietal side. There is effacement of the anterior horn of the left lateral ventricle|
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| Discussion|| |
The obtained results showed a male preponderance of 64.2%, with a male-to-female ratio of 1.8:1. This agrees with the findings of Muralidhar and Venugopal and Hirani and Shrivastva whose analysis yielded 1.85:1 and 1.8:1, respectively., This also agrees with many other authors around the world.,, However, the findings of Kaur et al. and Ezeala-Adikaibe et al. showed ratios of 1.7:1 and 1.34:1 which differ from our findings and many other ratios around the world., Further, Paul et al. insisted that the gender preponderance differs in different African countries, with some West African studies differing from those from East Africa. However, Owolabiand Ogunniyi stated that the male preponderance of 1:8 in their study is similar to the findings in other studies among Africans and Caucasians., This male preponderance has been attributed to the pattern of hospital attendance in this environment where males are exposed to more occupational and social epileptogenic insults, such as head injury. It is also thought that, in most parts of Africa, males do readily present to hospitals since they are the main sponsors of most family visits when health challenges occur.
The most affected age group who presented for the CT imaging was within the third decade of life (ages 20–29), constituting 30.9% of the study population. This age distribution and those found in other studies in Nigeria appear similar to that described among the Caucasians. However, this is low compared to Jallon et al., who stated that 57% of their patients were within the second decade of life. Our study and those of many others confirm that patients in the second decade of life are most affected.,, Whatever the value of sex preponderance, this high prevalence in young adults has important consequences for both the workforce and community structures.
Of the total number, it was noted that 18 patients (19%) presented with headache as an associated symptom either before or after seizures, followed closely by hemiparesis which was seen in 18%. Other associated symptoms are irrational behavior (16%), background history of trauma (14%), retroviral disease (12%), loss of consciousness (12%), and hypertension (9%). The least associated presenting symptom is those with background history of hypertension, which was seen in 9 (9.6%). Fever was the clinical sign accompanying seizures more frequently (23.8%) followed by critical postictal coma (19.8%). In a study by Kaur et al., it was discovered that stroke was the leading etiologic cause, followed by idiopathic and central nervous system infections. Furthermore, Garcia et al. showed that neurocysticercosis is a significant cause of seizures in Latin America. Other causes are tumors, cerebrovascular accident [Figure 2], intracranial central nervous system infection [Figure 3],, and malaria parasites.
|Figure 2: Intracerebral hyperdense areas in both hemispheres, with surrounding edema, in keeping with acute intracerebral hemorrhages|
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|Figure 3: Shows multiple abscesses both within and outside the right cranial vault. Multiple satellites are noted in the contralateral cerebral hemisphere|
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For the imaging findings, more than a quarter (26.7%) of the patients showed normal CT findings, while 73.3% had varying forms of abnormalities. This finding is lower than that of the findings of Ezeala-Adikaebe et al. and the WHO African Regional Study, who had slightly higher values of 30%,, and Roy and Pandit, who had 39%. On the other hand, Hirani and Shrivastva reported normal findings in 40% of their patients. Among the abnormal findings, 25 (18.5%) patients showed effacement or dilatation of the lateral ventricles. Other findings, in order of frequency of occurrence, are cerebral hypodensity (18.5%), prominent sulci (12.6%), cerebral atrophy (8.2%), cerebral cystic (8.2%), solid (2.2%) and calcific masses (1.5%), dilated 3rd/4th ventricles, and eroded cranial floor. Other findings constituted about 14.8%. One patient each showed a serpiginous vascular mass and arteriovenous malformation (0.7% each). Compared to the findings of Ruberti in East Africa, the leading causes of seizures are intracranial hemorrhage and tumors.
Seizures are globally recognized disorders since antiquity and are frequently encountered during medical practice, worldwide. It is one of the common and serious neurologic disorders in the world affecting at least 50 million people worldwide., Seizures continue to take its toll among people in developing countries, causing impaired physical, psychological, and social functioning of those affected, with serious psychological, social, and economic consequences for their families. Unfortunately, it occurs more in the developing countries of Africa and South America where healthcare resources are comparatively scarce, compared to the developed countries of Europe and North America., Even within the developed world like the United States, it is commonly found in the lower socioeconomic groups and rural areas. In Africa, the Sub-Saharan region of the continent is also more affected. The commission on tropical disease of the International League Against Epilepsy listed several diseases as the causes of seizures/epilepsy, which include trauma, malaria, tuberculosis, schistosomiasis, acquired immunodeficiency syndrome, and cysticercosis.,,,
Brain imaging is a veritable tool in the evaluation of seizures., These imaging modalities have impacted the diagnoses and management of all forms of seizures., This has also transformed the practice of neuroradiology and clinical neurology., A consensus statement both from the American Colleges of Emergency Physicians and American Academy of Neurology states that immediate neuroimaging should be done in patients who present with seizures and those with suspected structural brain lesions. This consensus has further strengthened the importance of imaging in the diagnoses of seizure disorders.
Although the use of CT has been greatly diminished by magnetic resonance imaging (MRI), CT is still the technique of choice for the investigation of patients with seizures under certain conditions, such as lower cost, fast scan, easy accessible, and easy to use., It is also an alternative to MRI for patients who cannot undergo MRI, due to body metallic implants and severe claustrophobia. In developing country like ours, MRI is not easily accessible. Hence, CT scan is the preferred imaging technique for patients presenting with seizure in our part of world.
| Conclusion|| |
This study shows male preponderance of adult with seizures, with the highest frequency in the third decade of life. Headache and hemiparesis are the most common presenting complaints. Like in other findings, this study shows that there is male preponderance in the hospital attendance among adult patients presenting with seizures, and young adults within the third decade of life are affected most. This is not good for a developing economy like ours. However, the presenting symptoms of convulsions and CT findings vary among the different communities. In this environment, headache was the highest presenting symptom, followed closely by hemiparesis, while the CT showed that cerebral hypodensity was the most frequent finding.
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Conflicts of interest
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]