Analysis of Focal Seizures with CT Correlation

Uma Maheswari, E (2008) Analysis of Focal Seizures with CT Correlation. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: As early as 400 B.C. when Hippocrates wrote about epilepsy till the present day when medical sciences have reached the heights of sophistication with various investigations like Computed Tomography, Magnetic Resonance Imaging and Positron Emission Tomography, epilepsy – a common neurological disorder, remains an enigma. Epilepsy is a clinical state, or syndrome, whereby a person is liable to recurrent epileptic seizures. Epilepsy may arise from a constitutional predisposition or as a consequence of acquired pathology and isolated seizures may be precipitated by a wide range of transient metabolic disturbances. A constitutional predisposition most commonly presents with so called primary generalized epilepsy whereas acquired pathology often produces focal epilepsy. The physician’s approach to a patient with epilepsy necessitates that he or she should first define the nature or type of the patient’s seizures, then if possible, determine the site in the brain from which they are arising and finally specify the nature of the underlying pathology or pathophysiology. This idea, which cannot always be achieved in full, is particularly applicable to patients with focal epilepsy. In the past, a large number of cases were labeled as epilepsy of unknown origin. Advances in imaging have revolutionized the ability to visualize the lesions in the brain that cause neurologic dysfunction. The introduction of computed tomographic scan (CT scan) particularly, has really helped to sort out the causes of epilepsy. It easily picks up focal calcifications, mass lesions, vascular lesions, abscesses, ring or disc enhancing lesions and other various innumerable abnormalities. Thus, the CT scan, one of the modern noninvasive investigation is a valuable tool in detecting intracranial abnormalities in patients with focal seizures. AIMS AND OBJECTIVES: 1. To detect various CT-scan abnormalities in patients with focal seizures. 2. Study the value of CT-scan Brain in diagnosing the etiological factor of focal seizures. 3. Correlation between clinical features and CT scan findings. MATERIALS AND METHODS: Thirty five patients with focal seizures who were admitted in the Neurology ward and General medical wards of Stanley Medical College Government Hospital during the period of Oct. 2006 to Oct. 2007, were enrolled for the study and was followed up. Patients with simple partial seizures, complex partial seizures and secondary generalized seizures were included in the study. Patients with recent head-injury, doubtful history, mental retardation and children below 12 yrs were not included in this study. A detailed history was recorded in each case (from the patient and intelligent attenders) regarding the age, number of episodes of seizures and parts of the body involved in the seizure have been recorded. Total duration of the seizure with shortest and longest interval between attacks and time of occurrence of fits in relationship with food and lunar cycles were also recorded. Important past history like ear discharge, psychosis, ECT, congenital, ischemic valvular heart disease, malignancy, exposure to STD, Pet rearing etc., were elicited and recorded. Dietary history regarding vegetarian and non-vegetarian was also taken. A thorough clinical examination was performed to detect any abnormality in CNS and screen for systemmic diseases with special attention to TB and cysticercosis. Once a clinical diagnosis of focal seizure was made, patients were subjected to relevant investigations, besides the routine investigations. Focal seizures due to Metabolic cause was ruled out. Both Plain CT-scan and Contrast enhanced CT-scan of brain was done in patients to look for any abnormalities which could have caused the seizure. In CT-scan structural abnormalities like calcification, granulomatous lesions, tumors, vascular anomalies, infarcts, bleed, infections and inflammations was studied and the pattern of contrast enhancement was also studied. Follow up CT scan was done in cases which showed curable lesion like TB and Cysticercosis and the changes noted. EEG was recorded in patients with normal CT scan or obvious metabolic abnormality to account for the seizure. A chest X-Ray was done in all cases to look for any supporting evidence of tuberculosis. All patients were started on anticonvulsant medications and specific treatments were given for different disorders after establishing the diagnosis. Patients in whom no specific etiology could be identified received only Anti epileptic drugs and they underwent a repeat CT-scan after a period of 12 – 16 weeks duration. SUMMARY AND CONCLUSION: 1. 80% of patients with focal seizures showed structural lesions on CT scan. 2. The highest incidence of partial seizures was in 31-40 age group. 3. Male to Female ratio 3:1. 4. Tuberculoma of the brain is the commonest cause of Partial Seizures present in 31.42% of our patients. 5. The next common cause was Neuricysticercosis in 14.28% of patients. 6. The most common site of involvement of tuberculoma are parietal and frontal lobes and no infratentonal lesions were observed. 7. Since Neuro-imaging alone will not help in exactly delineating between Tuberculoma and Neurocysticercosis. Other corroborative clinical evidence must be taken into account while arriving at a conclusion. 8. Patients with Single Solitary Lesions on CT scan with no clinical / investigational back-up to diagnosis can be put on AED & wait and watch policy adopted and repeat a CT - scan after 12 - 17 weeks. 9. Though MRI is more specific and sensitive, given the socio-economic set up of our country, CT scan still remains to be the most valuable tool in making the etiological diagnosis of partial seizures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Focal Seizures ; CT Correlation ; Analysis
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 16:08
Last Modified: 23 Mar 2018 16:08

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