Review of clinical presentation and radiological diagnosis in patients undergoing brain CT in Kenyatta National Hospital

Abstract

Introduction Brain CT and MRI are the current techniques of choice in investigation of brain pathology. MRI is available only in some institutions within the capital city while CT is more available in a number of our radiology departments. Plain radiography is useful in initial assessment of skull trauma and has minimal use in brain pathology assessment. CT can be used to pick up hemorrhage and calcification in a lesion. When contrast is administered, (depending on degree of uptake) it can be used to suggest if there is a breach in the blood brain barrier (thus aggressiveness of a lesion) or vascularity of the tumor. The density appearance of a lesion can be used to suggest the cellularity of a tumor. Brain CT remains a convenient, readily available and inexpensive way of characterizing various brain pathologies. The patients request form is an important means of communication between the clinician and the radiologist. It acts as a guide to the radiologist in understanding the condition of the patient especially when the radiologist is working in a busy institution and may not be able to interact with the patient to gather more information regarding the history of illness. Objective The main purpose of this study was to determine the clinical presentation and the radiological pattern of brain pathology as seen on brain CT scan examinations done in KNH. Methodology This was a retrospective descriptive study of the CT findings of patients who have undergone brain CT studies in the radiology department of KNH from January 2008 to June 2008. Results A total of 1221 head CT findings were evaluated during the study period. The male to female ratio was 1.1:1. The mean age was 33.4 years. Brain pathology was identified in 85.0% of the CT scans done. Pathologies encountered included trauma 21.4%, neoplasm's 18.0%, inflammatory conditions 16.8%, and brain atrophy 10.2%. Clinical findings in patients with a normal CT scan of the head included - seizures 33.3%, headache 26.8% and meningitis 20.2%. Clinical presentation encountered included injury related to trauma 19.7%, lateralizing signs 11.9%, headache 11.2% and convulsions/seizures 10.0%. Conclusion Majority of the patients undergoing a brain CT scan fall in the 21-40 years age group and are of male gender. Trauma related diagnosis and neoplasms are the commonest radiological diagnosis in patients undergoing head CT in KNH, while history related to trauma and lateralizing signs are the leading causes of clinical presentation. Patients with a normal CT scan of the head approximately half of them will have presented with seizures and about a third will have presented with headaches.