1. 100 consecutive patients (60 males and 40 females) who had CT brain studies performed between 6 p.m.
and 8 a.m.
in MUH were identified (date range (1/10/2017 to 1/12/2017).
2. The indications for and the reports for all of these studies were reviewed by two of the three authors.
3. Any relevant follow-up brain imaging in MUH was reviewed.
4. Patients who had intravenous thrombolysis were identified (on the basis of clinical information provided,
and having had follow-up brain imaging post treatment).
Results:
1. Clinical indications for the CT studies are outlined in Fig.1.
a. Most (55%) were based on a history of trauma or possible head injury.
(Ages 6-99)
b. 29% were requested because of possible stroke
c. 10% were requested because of clinical suspicion of intracranial haemorrhage (subarachnoid or subdural)
d. The 2 studies under “Other” include a patient with a severe frontal headache and vertigo,
and a patient intended for lumbar puncture (the clinical request asked that ‘raised intracranial pressure be excluded’).
2. Abnormalities were reported on 30 of these 100 CTs.
(Fig.2).
a. Old ischaemic changes were found in 13,
incidental developmental anomalies in 4,
acute infarcts in 3,
tumours in 2,
subarachnoid haemorrhage in 1 and a possible basilar tip aneurysm in 1.
b. “Other” includes 3 patients with minor global atrophy,
2 patients with sinusitis,
and 1 patient with a scalp haematoma.
c. The possible basilar tip aneurysm was later ruled-out following MRI.
3. 29 of the 100 patients reviewed had CT brains based on possible acute stroke,
presumably with a view to consideration for intravenous thrombolysis (ages 72-88).
a. Of these 29 patients,
0 were treated with thrombolysis.
b. Of these 29 patients 14 had follow-up brain imaging.
4. Of the total 100 patients,
29 had follow-up brain imaging (MRI,
MRI angiogram,
MRI venogram,
CT angiogram,
repeat CT (fig.3)),
with abnormalities found in 17.
5. Findings of the follow-up imaging are illustrated in fig.4.
a. In 5 patients,
acute/subacute infarction was identified on follow-up imaging (MRI in all cases).
All of these had initially had CT imaging based on an indication of a possible stroke.
b. 6 had white matter disease (probably ischaemic) or old infarcts
c. 2 had sinusitis
d. 1 each had post-operative changes,
stable demyelination,
metastatic deposits and subarachnoid haemorrhage.
e. Follow-up imaging was normal in 12 patients.