scholarly journals Approach to an adult with an episode of seizure

2022 ◽  
Vol 7 (4) ◽  
pp. 266-274
Author(s):  
Divya K P ◽  
Ajith Cherian
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Injury Risk ◽  
Closed Head Injury ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Cerebral Lesions ◽  
Stimulant Use ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

A patient with known epilepsy who has had a single, habitual seizure and whose mental status has returned to baseline need not be transported to the emergency department (ED) unless other injuries require so, whereas a patient with no history of epilepsy who has returned to baseline following a seizure should be evaluated. The evaluation should include basic biochemical parameters, toxicology screening and a brain imaging. One should investigate circumstances that may have precipitated a seizure, such as alcohol withdrawal, stimulant use, or head injury. Risk of recurrence of seizures is more likely in those with a history of significant brain injury or infection. If the patient has a normal magnetic resonance imaging (MRI) and electroencephalograph (EEG), the likelihood of a second seizure is approximately 1 in 3; if either test result is abnormal, the chances are approximately 1 in 2; if both are abnormal, the probability rises to 2 in 3. Computed tomography (CT) scan head is very useful in the evaluation of first seizure in infants less than six months of age. The clinical characteristics predictive of an abnormal CT scan for patients presenting with seizures were age less than 6 months or age greater than 65 years, history of cysticercosis, altered mentation, closed head injury, recent cerebrospinal fluid (CSF) shunt revision, malignancy, neurocutaneous disorder and seizures with focal onset or duration longer than 15 minutes. MRI has been shown to be superior to CT for the detection of cerebral lesions associated with epilepsy.

Reliability of the radiopharmaceutical shunt flow study for the detection of a CSF shunt malfunction in the presence of stable ventricular size

2020 ◽  
Vol 26 (4) ◽  
pp. 364-370
Author(s):  
Jeffrey J. Quezada ◽  
J. Gordon McComb
Keyword(s):  
Ct Scan ◽  
Operative Intervention ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Technical Failure ◽  
Ventricular Size ◽  
Shunt Flow ◽  
Programmable Valve ◽  
Flow Study

OBJECTIVEThe authors sought to determine the reliability of a radiopharmaceutical (RP) shunt flow study for the detection of a CSF-diverting shunt malfunction in the presence of stable ventricular size.METHODSAfter the authors obtained IRB approval, all CSF RP shunt flow studies done between January 1, 2014, and January 1, 2019, in pediatric patients at Children’s Hospital Los Angeles were identified. Included in the study were only those patients in whom an MRI or CT scan was done during the hospital admission for shunt malfunction and showed no increase in ventricular size compared with the most recent prior MRI or CT scan when the patient was asymptomatic. Data recorded for analysis were patient age and sex, etiology of the hydrocephalus, shunt distal site, nonprogrammable versus programmable valve, operative findings if the shunt was revised, and follow-up findings for a minimum of 90 days after admission. The RP shunt flow study consisted of tapping the reservoir and injecting technetium-99m DTPA according to a set protocol.RESULTSThe authors identified 146 RP flow studies performed in 119 patients meeting the above criteria. Four of the 146 RP studies (3%) were nondiagnostic secondary to technical failure and were excluded from statistical analysis. Of the 112 normal flow studies, operative intervention was not undertaken in 102 (91%). The 10 (9%) remaining normal studies were performed in patients who underwent operative intervention, in which 8 patients had a proximal obstruction, 1 had a distal obstruction, and 1 patient had no obstruction. Of the 30 patients with abnormal flow studies, symptoms of shunt malfunction subsided in 9 (30%) patients and these patients did not undergo operative intervention. Of the 21 (70%) operated patients, obstruction was proximal in 9 patients and distal in 5, and for 7 patients the shunt tubing was either fractured or disconnected. Regression analysis indicated a significant association between the flow study interpretation and the odds for shunt revision (OR 27, 95% CI 10–75, p < 0.0001). No other clinical variables were significant. The sensitivity of a shunt flow study alone for detection of shunt malfunction in cases with stable ventricular size was the same as a shunt flow study plus an MRI or CT (70% vs 70%), but performing a shunt flow in addition to MRI or CT did increase the specificity from 92% to 100% and the accuracy from 87% to 94%.CONCLUSIONSRP shunt flow studies were of definite value in deciding whether to operatively intervene in patients with symptoms of shunt malfunction in whom no change in ventricular size was detected on current MRI or CT scans compared to scans obtained when the patients were asymptomatic.

Can CT Scan Findings Predict Intracranial Pressure in Closed Head Injury Patients?

1980 ◽  
pp. 48-53 ◽  
Author(s):  
F. L. Haar ◽  
V. K. Sadhu ◽  
R. S. Pinto ◽  
P. L. Gildenberg ◽  
J. M. Sampson
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Ct Scan ◽  
Closed Head Injury ◽  
Closed Head

Pitfalls in the determination of intracranial spread of complicated suppurative sinusitis

1996 ◽  
Vol 110 (7) ◽  
pp. 673-675 ◽  
Author(s):  
B. J. Conlon ◽  
A. Curran ◽  
C. V. Timon
Keyword(s):  
Ct Scan ◽  
Previous History ◽  
Ct Scanning ◽  
Clinical Findings ◽  
Intracranial Extension ◽  
Sinus Disease ◽  
Grand Mal ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

AbstractWe present two cases of suppurative sinusitis that presented to our casualty department over a one-week period. Both patients suffered complications of the disease secondary to extension of the inflammatory process beyond the bony confines of the sinus. Neither of the patients had a previous history of sinus disease. The first patient deteriorated suddenly 24 hours after admission. The initial computed tomography (CT) scan failed to demonstrate a developing subdural empyema. This complication was confirmed following repeat scanning 24 hours later and the patient required urgent neurosurgical intervention and drainage. The second patient presented with periorbital cellulitis secondary to sinusitis and suffered a grand mal seziure on admission. Once again initial CT scan changes were subtle and significant intracranial extension was not noted until the subsequent magnetic resonance imaging (MRI) scan was performed.The purpose of this paper is to highlight the potential dangers over reliance on CT scanning in diagnosing early intracranial spread of sinus disease and we emphasise that the clinician must interpret any radiological investigations in light of the associated clinical findings.

Coincidental Pituitary Adenoma and Parasellar Meningioma: Case Report

Neurosurgery ◽  
1986 ◽  
Vol 19 (2) ◽  
pp. 267-270 ◽  
Author(s):  
Kenji Yamada ◽  
Takashi Hatayama ◽  
Masahiro Ohta ◽  
Katsuaki Sakoda ◽  
Tohru Uozumi
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Head Injury ◽  
Ct Scan ◽  
The Other ◽  
Histopathological Findings ◽  
Computed Tomographic ◽  
First Case ◽  
History Of

Abstract We report a patient who had pituitary adenoma and parasellar meningioma coincidentally, with neither irradiation nor a history of head injury. Preoperative computed tomographic (CT) scan had shown a large intrasellar mass with ringlike enhancement; in contact with this mass, another well-enhanced mass had been shown. Histopathologically, the intrasellar mass was diagnosed as chromophobic pituitary adenoma and the other mass as meningotheliomatous meningioma. We present clinical, radiological, and histopathological findings and discuss previously reported cases of coincidental pituitary adenoma and meningioma without irradiation. This is the first case report since the advent of CT that pituitary adenoma and parasellar meningioma in contact with each other could be clearly demonstrated by CT.

Elevated transcranial Doppler flow velocities after severe head injury: cerebral vasospasm or hyperemia?

1996 ◽  
Vol 85 (1) ◽  
pp. 90-97 ◽  
Author(s):  
Bertil Romner ◽  
Johan Bellner ◽  
Poul Kongstad ◽  
Hans Sjöholm
Keyword(s):  
Blood Flow ◽  
Head Injury ◽  
Ct Scan ◽  
Transcranial Doppler ◽  
Severe Head Injury ◽  
Single Photon ◽  
Photon Emission ◽  
Closed Head Injury ◽  
Thick Layer ◽  
Flow Velocities

✓ Sixty-seven patients (45 males and 22 females) aged 2 to 70 years (mean 36 years) who had suffered closed head injury were investigated with daily transcranial Doppler (TCD) recordings. A total of 470 TCD recordings (mean 7) were made during Days 1 to 14 after admission. Blood flow velocities were determined in the middle cerebral artery (MCA) and the extracranial internal carotid artery (ICA). Twenty-seven (40%) of the 67 patients demonstrated traumatic subarachnoid hemorrhage (tSAH) on the first computerized tomography (CT) scan after the injury. Flow velocities exceeded 100 cm/second in 22 patients. Eleven (41%) of the 27 patients who showed tSAH on the first CT scan developed velocities greater than 100 cm/second, as compared to 11 (28%) of 40 patients without tSAH on CT. Two patients in whom a thick layer of tSAH was revealed on the first CT scan had MCA flow velocities exceeding 200 cm/second for several days. Measurements of cerebral blood flow (CBF) with single-photon emission CT (SPECT) were performed in six tSAH patients who showed TCD flow velocities exceeding 120 cm/second (uni- or bilaterally) to determine whether the increase in velocity reflected vasospasm or hyperemia. The SPECT studies verified ischemia in five patients but revealed general hyperemia in one. The bilateral increase in MCA flow velocities in the latter case was due to high-volume flow through the MCA secondary to elevated CBF rather than arterial narrowing. In one patient with a thick layer of subarachnoid blood on a CT scan obtained at admission, MCA flow velocities exceeded 220 cm/second bilaterally on Day 8 after the head injury. A SPECT measurement obtained on the same day reflected bilateral ischemia. In this patient flow velocities decreased, with a corresponding normalization of CBF, after 5 days of intravenous nimodipine administration. The MCA/ICA ratio correlated well with the distribution of CBF in the six patients studied using SPECT. This report suggests that vasospasm is an important secondary posttraumatic insult in patients suffering severe head injury and, in some cases, is probably treatable by administration of intravenous calcium channel blockers.

scholarly journals Constructional apraxia in patients with closed head injury

2005 ◽  
Vol 62 (5) ◽  
pp. 339-342
Author(s):  
Dragan Pavlovic ◽  
Aleksandra Pavlovic
Keyword(s):  
Head Injury ◽  
Closed Head Injury ◽  
Wisconsin Card Sorting Test ◽  
Card Sorting ◽  
Cerebral Lesions ◽  
Complex Figure ◽  
Significant Difference ◽  
Closed Head ◽  
Constructional Apraxia ◽  
The Right

Introduction. Constructional apraxia is a disorder characterized by an inability to join the elements into a unity. It has not been studied much in patients with closed head injury (CHI). Methods. Forty-one patients with CHI were examined, of which 11 (26.83%) were with the right-sided, 12 (29.27%) with the left-sided, and 18 (43.90%) with bilateral lesion using the Wechsler Individual Intelligence Test (VITI) - Serbian version, Rey Complex Figure (RCF) test, Trail Making Test - TMT A and B, and the Wisconsin Card Sorting Test (WCST). Results. Intelligence quotient (IQ) was significantly higher in the patients with the right-sided (95.27) and bilateral cerebral lesions (87.56) than in the left-sided (84.42). RCF scores did not show any significant difference regarding the side of the lesion, but was numerically the lowest scores were in patients with bilateral brain damage. Patients with left-sided lesions had the score of 30.63, right-sided of 28.68, and bilateral of 27.39. TMT B showed a significantly lower result in patients with the left-sided (196.50 seconds) and bilateral lesions (192.07 seconds) compared to the right-sided (140.14 seconds). WCST scores were not significantly different regarding the side of the lesion, but the absolute value of the categories was less than expected. Conclusion. Constructional apraxia was more frequently present in the patients with CHI than it was previously considered. The use of sensitive tests can show the presence of the disorder mainly in bilateral, but also in unilateral lesions.

Multidetector Computed Tomography (MDCT) Evaluation of Traumatic Brain Injury in Head Trauma Patients in Tertiary Hospital of Eastern Region of Nepal

2021 ◽  
Vol 6 (1) ◽  
pp. 1352-1357
Author(s):  
Ajay Kumar Yadav ◽  
Binit Dev ◽  
Sushil Taparia ◽  
Parvez Kumar ◽  
Rakesh Mandal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Ct Scan ◽  
Head Trauma ◽  
Road Traffic ◽  
Imaging Findings ◽  
Intracranial Lesions ◽  
History Of

Introduction: Traumatic brain injury (TBI) in patients with head trauma is common cause for emergency visits to hospital affecting all age groups. It is one of important leading cause of death and disability worldwide besides leading to neurological disease burden. Noncontrast enhanced Multidetector computed tomography (MDCT) is imaging modality of choice for detection of various intracranial lesions. Objectives: This study was done to analyse various imaging findings on MDCT in traumatic head injury patients along with association of CT findings with clinical manifestation and mechanism of injury. Methodology: In this ethically approved prospective study, CT scan was done in 224 consecutive patients with head injury from November 2020 to February 2021. The various imaging findings seen in CT scan were documented in proforma. The data collected was analyzed with appropriate statistical test and statistical significance was calculated. Results: Total of 224 patients with diagnosis of head injury were included in the study. The male to female ratio was 2.86 and most common age group involved was between 20-40years (41.1%). The most common mode of injury was road traffic accidents (57.6%) and most of the patients presented with history of altered sensorium (35.7%). About 47.3% patients showed abnormal findings on CT scan with scalp lesion was most common findings (82%) followed by skull fractures (54.7%) and cerebral contusions (43.4%). Patients with history of RTA had more abnormal CT scan (62%) than fall injury and physical assault. Statistically significant association seen between CT scan findings with Glasgow Coma Scale and RTA (P<0.05). Conclusion: The present study showed well documented role of CT scan in diagnosis of TBI besides detection of spectrum of intracranial lesions in patients with head trauma. Road traffic accident is most common mode of head injury with most of the victims are young middle age active male. 

scholarly journals Adalimumab Induced or Provoked MS in Patient with Autoimmune Uveitis: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Rana Alnasser Alsukhni ◽  
Ziena Jriekh ◽  
Yasmin Aboras
Keyword(s):  
Family History ◽  
Autoimmune Diseases ◽  
Safety Data ◽  
Cerebral Lesions ◽  
Case Presentation ◽  
Autoimmune Uveitis ◽  
Relative Safety ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Necrosis Factor

Anti-tumor necrosis factorα(anti-TNF-α) agents have been widely used in the field of autoimmune diseases and have proved decisive efficacy and relative safety. Data concerning their adverse effects has been lately describing central nervous system (CNS) demyelination process at escalating basis.Case Presentation. A 23-year-old male with autoimmune uveitis and a family history of multiple sclerosis (MS) developed two neurological attacks, after Adalimumab infusion, simultaneously with several cerebral lesions on magnetic resonance imaging (MRI). Hence the diagnosis of Adalimumab induced MS was suspected.Conclusion. This case is reported to tell physicians to be cautious when using anti-TNF-αin patients with family history of MS and to reconsider the risk of MS in patients with autoimmune diseases.

scholarly journals Clinical predictors of abnormal head computed tomography scan in patients who are conscious after head injury

2017 ◽  
Vol 08 (01) ◽  
pp. 064-067 ◽  
Author(s):  
Rakesh Kumar Mishra ◽  
Ashok Munivenkatappa ◽  
Vasuki Prathyusha ◽  
Dhaval P. Shukla ◽  
Bhagavatula Indira Devi
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Ct Scan ◽  
Clinical Features ◽  
Significant Risk ◽  
Observation Study ◽  
Head Ct ◽  
Abnormal Head ◽  
History Of ◽  
Head Computed Tomography

ABSTRACT Background: Indication of a head computed tomography (CT) scan in a patient who remains conscious after head injury is controversial. We aimed to determine the clinical features that are most likely to be associated with abnormal CT scan in patients with a history of head injury, and who are conscious at the time of presentation to casualty. Materials and Methods: This is a prospective observation study of patients presented to casualty with history of head injury, and who were conscious, i.e., Glasgow Coma Scale (GCS) 15 at the time of evaluation. All patients underwent head CT scan. The CT scan was reported as abnormal if it showed any pathology ascribed to trauma. The following variables were used: age, gender, mode of injury (road traffic accident, fall, assault, and others), duration since injury, and history of transient loss of consciousness, headache, vomiting, ear/nose bleeding, and seizures. Logistic regression analysis was used to identify the clinical features that predicted an abnormal CT scan. Results: During the observation period, a total of 1629 patients with head injury were evaluated, out of which 453 were in GCS 15. Abnormal CT scan was present in 195 (43%) patients. Among all the variables, the following were found significantly associated with abnormal CT scan: duration since injury (>12 h) P < 0.001; vomiting odds, ratio (OR) 1.89 (1.23, 2.80), P < 0.001; and presence of any symptom, OR 2.36 (1.52, 3.71), P < 0.001. Conclusion: A patient with GCS 15 presenting after 12 hours of injury with vomiting or combination of symptoms has a significant risk of abnormal head CT scan.

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