Computed tomographic study in seizure disorder

 

 

Abstract              Background: To study the CT scan characteristic in patient with seizure disorder and categorize the nature of lesion. Materials and methods: This study was conducted on 100 patients with seizure disorder came to Radiology department of SP Medical College Bikaner. Observations and Results: Analysis of cranial CT scan showed normal study in 45% of the cases and abnormalities in 55% of the cases. CT scan abnormalities were classified as infectious, post infectious, neoplastic, cerebrovascular disease, congenital lesions, traumatic lesions, post traumatic sequele, tubercular infection and neurocysticercosis. Seizure disorder is a common neurological disease with different aetiologies. Neuro imaging is important diagnostic and prognostic tool in evaluation of patient with seizure disorder. CT scan is often initial investigation in emergency situations. CT scan is cost effective diagnostic tool developing countries with limited resources. Conclusion: CT scan useful diagnostic modality in evaluation and management of patient of seizure disorder.

Keywords: brain, cranial, CT scan, seizure.

 

INTRODUCTION

Knowledge of etiopathogenesis of seizure disorder is of paramount importance in planning and executing effective treatment. In many cases however no lesion of any description could be demonstrated. Moreover, an organic lesion of brain of some nature may be associated with seizure in many cases. Improved investigation techniques like computed tomography (CT scan), magnetic resonance imaging (MRI), position emission tomography (PET), single photon omission computerized tomography (SPECT) and isotope brain scanning all have provided invaluable tools for detection and localisation of structural abnormalities of the brain in patients of seizure disorder. CT scan can provide a sensitive and reproducible method for evaluating suspected lesion in central nervous system. It is often the investigation of choice of evaluating the CNS lesion whether or not other modalities like MRI are available. CT scan system consists of three main components (1) Imaging system (2) scanning system (3) power cabinet. The majority of scanners in use at present are third-generation rotate only system.

Classification of seizures

1. Partial seizure-
2. Simple partial seizure
3. Complex Partial seizure
4. Partial seizure with secondary generalization
5. Primary generalized seizure-
6. Absence or Petit mal seizure
7. Tonic clonic seizure or Grand Mal seizure
8. Tonic
9. Atonic
10. Myoclonic
11. Unclassified seizure-
12. Neonatal seizure
13. Infantile seizure

The likely etiology of given seizure depend on age of the patient and type of the seizure. In neonates’ common causes are perinatal hypoxia, ischemia, metabolic disturbance, developmental disorder, genetic disorder, trauma, acute CNS infection and intracranial haemorrhage. In infants and children of less than 12-year common causes are febrile seizure, CNS infections, development and genetic disorders and idiopathic. In adolescent between age of 12 - 18 years common causes are trauma, infections, genetic disorder, brain tumours, drug abuse and idiopathic. In young adults between age of 18 - 35-year causes are alcohol withdrawal, trauma, illicit drug use, brain tumour and idiopathic. In older adults more than 35 year of age causes are generally brain tumour, alcohol withdrawal, cerebrovascular disease, metabolic disorder, idiopathic, Alzheimer disease and other degenerative CNS disease.

AIMS AND OBJECTIVES

1. To show the roles of CT scan head in evaluation of patient with seizure disorder.
2. To characterize the nature of lesion by CT scan head study in patient of seizure disorder.
3. To study the organic causes of seizure disorder by CT scan head characteristic.

 

MATERIALS AND METHODS

This study was conducted on 100 patients with seizure disorder reporting to various emergency, inpatient and outpatient departments and referred to department of radiodiagnosis in Sarder Patel Medical College Bikaner. General particulars of the patient such as age, sex, residence, occupation, religion, drug history, dietary history was noted. The concerned referring clinician’s account of presenting complaint of each patient was documented. Further details of present and past history of illness were elucidated from the patient or attendant as per circumstances. Physical examination in general and CNS examination in particular was conducted. Results of all investigation which were undertaken were recorded particularly X ray skull, EEG report and various blood investigations.

Following registration cranial computed tomographic evaluation of each patient presenting with seizure was done on SomaTom art, 3rd generation rotate type whole body CT scanner from Siemens and high speed NX/ 1 pro dual slice from GE which was installed in our hospital.

Technique: The patient was kept in supine position with table position adjusted to individual need. The head was immobilized with in a special headrest with special head support. Facilities for proper immobilisation were provided and patient was given instruction to avoid any movement. Restless patients and children were sedated as required. First a sagittal planning topogram scanogram was acquired at low resolution. This image served to determine the desired scan angle and planes. The orbit m et al. lines were selected because these fixed points are readily defining the top of orbit and external auditory meatus. Then the axial CT sections of the entire cranial cavity and its content were taken. Generally, slice thickness of 10mm was selected. However, slice thickness was adjusted as per requirements. The gantry was tilted to an appropriate degree so as to obtain a plane of section of 15 -20 degree to canthomeatal line. Computer programs of magnification distance and density measurement and viewing at proper window level was utilised. Additional contrast-enhanced scan was performed as and when required by IV injection of appropriate dose of contrast medium after sensitivity testing.

CT head findings were read as follows

Soft tissue structure - any bruises or tumour.

Quadrigeminal and basal cistern-normal or brain stem herniation.

Size and contour of ventricles and subarachnoid space- Appropriate for the age of patient, any dilatation, obstructive /non–obstructive hydrocephalus.

Any mid line shift of the structures.

Periventricular white matter and cortex –insconspious and well-defined local lesion, local edema

Basal ganglia, internal capsule, brainstem, pons, cerebellum.

Calcification, focal/diffuse lesions, hypodense/ hyperdense, location, size, shape, number, margin, density. Surrounding tissue and enhancement pattern.

Bony details- fracture, metastasis.

Finally, the conclusion of CT findings was made.

 

 

 

 

 

 

 

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