Hyperacute Seizure: CT Head

Exam

Non-Contrast Screening Head CT

Purpose

1. Is there evidence of focal edema or swelling in either hippocampus-seldom is seen outside of status epilepticus.

2. Identify all areas of chronic post ischemic (or post traumatic/postoperative) damage, including encephalomalacia, subcortical leukomalacia, ischemic demyelination, shrunken gyri/ulegyria, since they will exhibit reduced Q on the CTA & CT perfusion.

3. Identify any periventricular calcification to exclude prior TORCH infections, since they often have associated seizures/epilepsy.

4. Identify any site of cerebral malformation or dysgenesis including tuberous sclerosis and NF1 in particular.

5. Is there evidence of early hydrocephalus, PRES, pseudotumor, optic hydrops, or early brain herniations.

6. Is there evidence of aggressive sinusitis/otomastoiditis/parapharyngeal infection as a cause for meningitis, empyema, brain abscess, cavernous sinus/sphenoparietal sinus/cortical vein thrombosis, all of which can present with a seizure.

Prior Study

None

Findings

Non-Contrast CT Head

There is evidence of recent intracranial (subarachnoid/cisternal/intraventricular) hemorrhage. [Yes/No]

There is evidence of focal edema or mass effect consistent with underlying parenchymal abnormality (i.e. foreign tissue lesion or FTL as in stroke, brain tumor, encephalitis, etc.). [Yes/No]

There is regional loss of sulci with compression of cisterns, and ventricles indicative of local mass effect, or pseudotumor cerebri, etc. [Yes/No]

There is global background CT density asymmetry between the cerebrum vs cerebellum (only evident when using narrow/high contrast window widths), which if present, is consistent with global hypoxic-ischemic (HIE) event where the cerebrum is uniformly hypodense and the cerebellum is actually normal or near normal. [Yes/No]

There is evidence of dural sinus or cortical vein thrombosis. [Yes/No]

There is abnormal brain calcification consistent with prior TORCH infection, as a cause of a seizure event. [Yes/No]

There is apparent parenchymal dysgenesis (i.e. Sturge-Weber, NF, tuberous sclerosis, etc), or brain formation anomaly, as a cause of a seizure event. [Yes/No]

There is evidence of aggressive otomastoid or paranasal sinus infectious disease, which could lead to cortical vein phlebothrombosis or dural sinus thrombosis. [Yes/No]

There are one or more lacunar defects or areas of encephalomalacia or evidence of subcortical leukomalacia consisent with post ischemic injury, or multiple other etiologies as trauma, post encephalitis, post HIE, toxic encepalopathy, etc. [Yes/No]