Assessment of the usefulness of magnetic resonance brain imaging in patients presenting with acute seizures

• Published in: Irish journal of medical science Vol. 183; no. 4; pp. 621 - 624
• Main Authors: Olszewska, D. A., Costello, D. J.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-12-2014
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Brain - diagnostic imaging; Brain Diseases - complications; Brain Diseases - diagnosis; Family Medicine; Female; General Practice; Humans; Internal Medicine; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroimaging; Original Article; Prospective Studies; Seizures - diagnostic imaging; Seizures - etiology; Tomography, X-Ray Computed; Young Adult; CT; MRI; Epilepsy; Acute seizures
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-013-1061-4

Background
Magnetic Resonance Imaging (MRI) is increasingly available as a tool for assessment of patients presenting to acute services with seizures.
Aims
We set out to prospectively determine the usefulness of early MRI brain in a cohort of patients presenting with acute seizures.
Methods
We examined the MR imaging studies performed in patients admitted solely because of acute seizures to Cork University Hospital over a 12-month period. The main aim of the study was to determine if the MRI established the proximate cause for the patient’s recent seizure. We identified 91 patients who underwent MRI brain within 48 h of admission for seizures.
Results
Of the 91 studies, 51 were normal (56 %). The remaining 40 studies were abnormal as follows: microvascular disease (usually moderate/severe) (
n
 = 19), post-traumatic gliosis (
n
 = 7), remote symptomatic lesion (
n
 = 6), primary brain tumour (
n
 = 5), venous sinus thrombosis (
n
 = 3), developmental lesion (
n
 = 3), post-surgical gliosis (
n
 = 3) and single cases of demyelination, unilateral hippocampal sclerosis, lobar haemorrhage and metastatic malignant melanoma. Abnormalities in diffusion-weighted sequences that were attributable to prolonged ictal activity were seen in nine patients, all of who had significant ongoing clinical deficits, most commonly delirium. Of the 40 patients with abnormal MRI studies, seven patients had unremarkable CT brain. MR brain imaging revealed the underlying cause for acute seizures in 44 % of patients. CT brain imaging failed to detect the cause of the acute seizures in 19 % of patients in whom subsequent MRI established the cause.
Conclusion
This study emphasises the importance of obtaining optimal imaging in people admitted with acute seizures.