Abstract

Introduction: In Indian medical practice assessment of patients presenting with seizure is a challenge for a physician in evaluating and treating them. After introduction of neuroimaging in seizure, they have been a great boon both for diagnosis of cerebral lesions as well as clinical management of patients with neurological impairments.

Objective: To study the neuroimaging findings in patients presenting with seizure and to determine etiology and to correlate type of seizure with neuroimaging findings.

Study Design: Hospital based cross sectional study

Study Setting: This study was done in department of Internal medicine, VIMSAR, ODISHA

Study Duration: Study duration was from October 2016 to September 2018 (24 months)

Subjects and Methods: Total 212 cases of age > 14 years who presented with seizure were studied and patients having implants, pregnant and claustrophobic patients were excluded. All the patients were subjected to CT scan and MRI of brain by a 160 slice CT scan machine and 1.5 tesla MRI scanner respectively. Various details of neuroimaging findings were studied like- Any lesion present, signal intensity/density, surrounding edema, haemorrhage, atrophy, infarction, mass effect, contrast enhancement / enhancing lesions, calcification, developmental malformations, hydrocephalus.

Results: 51.9% of study population (110) were males and 48.1% (102) were females. The mean age of study population was 39.5 with a standard deviation of 16.3.All patients were subjected to CT scan and 117 cases (55.2%) had normal CT scan. 95 cases had abnormal CT findings. On MRI brain abnormality was detected in 50% of total cases. i.e. 106 out of 212 cases. In our study MRI of brain diagnosed glioma, multiple sclerosis and meningoencephalitis which could not be detected on CT. The most common abnormalities were infarction (28 cases), tuberculoma (21 cases), neurocysticercosis (16 cases).130 patients presented with GTCS out of which 64 (49.2%) cases had abnormal neuroimaging findings. 74 patients presented with focal seizure out of which 39 (52.7%) cases had abnormality. 7 patients presented with myoclonic seizure out of which 3 (42.8%) cases had abnormality. 1 case presenting as absence seizure had normal MRI. Out of 106abnormal MRI findings, 45 patients had vascular, 41 had infective 7 had neoplastic and 13 had other etiologies.

Conclusion: Neuroimaging has 50% chance of finding any abnormality of brain in patients presenting with seizure. Hence it plays an important role in diagnosis and must be performed in all patients presenting with seizure.MRI plays an important role with its precise diagnosis like glioma and is more effective than CT scan in diagnosis of patients presenting with seizure. Patients presenting with focal seizure had the highest neuroimaging abnormality. In our study population of western Odisha vascular abnormalities were highest. In addition to it frequency of infective causes of seizure was also high in this area.