Frequency of Computed Tomography Brain Findings and Their Association with Clinical Features in Patients Presenting with Seizures at Lady Reading Hospital, Peshawar

Abstract

Seizures are a common neurological emergency caused by diverse structural, metabolic, infectious, and vascular conditions. Early identification of the underlying cause is essential for appropriate management. Computed tomography of the brain is frequently used as the initial imaging modality because it is rapid, widely available, and effective in detecting major intracranial abnormalities. Objective: To evaluate CT brain findings in patients presenting with seizures, determine the frequency and pattern of abnormalities, and assess their association with clinical features and seizure types. Methods: This retrospective study included 303 patients presenting to the Radiology Department of Lady Reading Hospital, Peshawar, with seizures from September 2025 to March 2026. Demographic and clinical information, including presenting symptoms and seizure characteristics, was obtained from patient records. All patients underwent non-contrast CT brain examinations. CT findings were reviewed and categorized as normal or abnormal, and radiological abnormalities were correlated with clinical features. Data were analyzed using appropriate statistical methods, with a p-value <0.05 considered statistically significant. Results: In total, 303 patients, 163 (53.8%) had abnormal CT findings, while 140 (46.2%) showed no significant abnormalities. Most patients were aged 1–15 years (22.8%), and males predominated (63%). Headache (35.9%), loss of consciousness (23.4%), and fever (18.9%) were the most common presenting symptoms. Focal seizures were observed in 34% of patients, compared with 19.8% with generalized seizures. Infarction (22.2%) was the most frequent CT abnormality, followed by brain atrophy (17.9%), hydrocephalus (15.9%), and intracranial hemorrhage (4.3%). Significant associations were observed between loss of consciousness and intracranial hemorrhage (p=0.003), headache and hydrocephalus (p<0.001), and brain edema (p=0.007), and between fever and ischemic infarction (p=0.001) and hydrocephalus (p<0.001). Conclusion: CT brain is a valuable imaging modality for evaluating patients presenting with seizures, with more than half demonstrating structural abnormalities. Vascular lesions, particularly infarction and intracranial hemorrhage, were the most common findings. Significant associations between clinical features and CT abnormalities highlight the importance of integrating clinical assessment with imaging to facilitate accurate diagnosis and appropriate patient management.