First-ever generalised tonic-clonic seizures in adults in the emergency room: Review of cranial computed tomography of 76 cases in a tertiary hospital in Benin-city, Nigeria

Abstract

Objective: To determine the prevalence of intracranial lesions in first-ever generalized tonic-clonic seizures in adults presenting in the Emergency Department (ED). Main outcome measure was the prevalence of intracranial lesions in cranial computerized tomography (CT).
Method: 76 consecutive patients aged 18 years and above, with first-ever, non-traumatic, generalised tonic-clonic seizures that were evaluated in the ED with cranial CT, had their CT films reviewed by a specialist Radiologist. Demographic characteristics of participants were computed. The participants were divided into two groups-the group with intracranial lesions and the other without and their characteristics were compared. Main outcome measure was the presence of intracranial lesions in cranial computerized tomography.
Results: Intracranial lesions were found in 57.9% of cases; cerebral atrophy and acute vascular disorders (strokes) were the leading lesions. Mean age of cases with intracranial lesions was higher compared with those with normal CT findings (55.31±17.33 years versus 38.90 ±14.69 years; p<0.001). Age above 29 years was predictive of intracranial lesions (O.R=1.109, p=0.01). Gender was not significantly associated with intracranial lesions (p=0.084). Clinical and CT diagnoses agreed only in 8.4% of the cases. (p=0.198).
Conclusion: In first-ever, non-traumatic, generalized, tonic-clonic seizures  in the ED, intracranial lesions are found frequently, cerebral atrophy and acute vascular insults are the leading intracranial lesions.

Keywords: First-ever, seizure, generalized, tonic-clonic, emergency, non-traumatic.