Cranial Computed Tomography in Neurologic Emergency Patients Without Head Injury at Chaoprayayomraj Hospital: A Retrospective Analysis

Abstract

Objective:  To evaluate the clinical presentations and the imaging findings of the patients without history of head trauma who had emergency cranial computed tomography (CT) at Chaoprayayomraj hospital.

Methods:  A retrospective analysis was performed in 328 patients without history of head trauma who had emergency cranial CT imaging at Chaoprayayomraj hospital during May 2009 to August 2009. The imaging findings were defined to be positive, if they revealed the causative diseases and to be negative, if they were normal or unrelated to the clinical presentation.

Results:  Of 328 patients, 179 were male and 149 were female, with mean age of 57.4 years. In 231 cases (70.4%) with positive CT findings were cerebral infarction (n = 176), intracranial hemorrhage (n = 26), CNS neoplasm (n = 16), intracranial infection (n = 12), and acute hydrocephalus (n = 1). In 97 cases (29.6%) with negative CT findings were normal (n = 69), age-related change (n = 14) and cerebral atrophy (n = 14). The most common presenting symptoms of the patients with positive CT findings were focal weakness (45%), followed by altered mental status (23.4%). The most common presenting symptoms of the patients with negative CT findings were seizure (24.7%), followed by headache (16.5%).

Conclusion:  Cerebral infarction was the most common non-traumatic neurological emergency. The results of this study revealed that the overall rate of cranial computed tomography scans ordered staffs at study emergency department was appropriate. Precise clinical evaluation is the most important tool for proper management and reduction of the unnecessary expense in those cases with negative CT findings. It also supports the development of guidelines for the using of head computed tomography scans in patients with seizure and headache.