Frequency, Causes and Findings of Brain Computed Tomography Scan at University of Lahore Teaching Hospital

Cranial computed tomography (CT) is the most generally utilized diagnostic method for the emergent evaluation of head trauma (TBIs) because it is readily accessible, quick, and sensitive for clinically relevant traumatic brain injuries as well as non-traumatic abnormalities. Objective: To determine the frequency, causes, and �ndings of brain computed tomography scan at The University of Lahore teaching hospital. Methods: A descriptive study was conducted at The University of Lahore Teaching Hospital. A sample of 202 brain CT scans from a total of 933 participants seen in the CT department was obtained using a suitable sampling technique. Data analysis was done using SPSS version 21.0. Results: There were 78 (38.6%) female patients and 124 (61.4%) male patients out of 202 total patients. The mean age of the patients was 47.1± 23 years. The most prevalent of them, brain atrophy, was observed in 63 (31.2%) of the patients. 51 (25.2%) patients had infarction, 36 (17.8%) had sinusitis, 24 (11.9%) had ischemic demyelination, and 16 (7.9%) had fractures and hemorrhages. In 8 (4.0%) patients, mastoiditis, tumors, and carcinoma were reported. 7 patients (3.5%) had cysts, 6 patients (3.0%) reported contusions, and 2 patients (1.0%) had abscesses. Conclusions: According to our research, the vast majority of individuals who underwent CT scans had a history of headache and falls and the most frequent observation in the patients was brain atrophy. Other major �ndings found were sinusitis and infarction.


I N T R O D U C T I O N
Cranial computed tomography (CT) is the most generally utilized diagnostic method for the emergent evaluation of head trauma (TBIs) because it is readily accessible, quick, and sensitive for clinically relevant traumatic brain injuries as well as non-traumatic abnormalities. Objective: To determine the frequency, causes, and ndings of brain computed tomography scan at The University of Lahore teaching hospital. Methods: A descriptive study was conducted at The University of Lahore Teaching Hospital. A sample of 202 brain CT scans from a total of 933 participants seen in the CT department was obtained using a suitable sampling technique. Data analysis was done using SPSS version 21.0. Results: There were 78 (38.6%) female patients and 124 (61.4%) male patients out of 202 total patients. The mean age of the patients was 47.1± 23 years. The most prevalent of them, brain atrophy, was observed in 63 (31.2%) of the patients. 51 (25.2%) patients had infarction, 36 (17.8%) had sinusitis, 24 (11.9%) had ischemic demyelination, and 16 (7.9%) had fractures and hemorrhages. In 8 (4.0%) patients, mastoiditis, tumors, and carcinoma were reported. 7 patients (3.5%) had cysts, 6 patients (3.0%) reported contusions, and 2 patients (1.0%) had abscesses. Conclusions: According to our research, the vast majority of individuals who underwent CT scans had a history of headache and falls and the most frequent observation in the patients was brain atrophy. Other major ndings found were sinusitis and infarction.
is the most often used diagnostic technique for the urgent evaluation of head trauma (TBIs). Although cerebral bleeding and skull fractures can be found using cranial CT, it is also sensitive to a variety of non-traumatic abnormalities that the patient or their family may not be aware of. CT can reveal soft-tissue abnormalities such disc herniation, soft tissue bleeding, and ligamentous rupture [7]. Due to its widespread availability and sensitivity to hemorrhage, computed tomography (CT) is used by the vast majority of institutions as the initial imaging test for patients with acute cerebral ischemia [8]. In the United States, traumatic head injuries a ict more than 1.7 million people annually, including about 500,000 children. 52,000 people pass away as a result [9]. Adults under the age of 45 and children up to the age of 15 years both suffer from head injuries more frequently than other causes. Neuronal and vascular tissue are compressed and sheared at the moment of impact in a head injury patient due to mechanical stresses. Further abnormal occurrences could result in brain damage. In this sense, a quick diagnosis and better patient care depend on the use of CT [10]. Around 7.5 million visits in patient care settings occur due to dizziness each year, and it is one of the most frequent presenting ailments in the emergency room (ED). Vertigo is the most prevalent type of dizziness, accounting for about 54% of complaints [11]. CT is routinely employed as a rst-line imaging modality to rule out posterior fossa bleeding or a big mass as a cause of vertigo [12]. Most people experience headaches at some point in their existence. They are a frequent symptom. Between 70 and 95 percent of Americans get headaches at least every other year [13]. An examination of the physical and neurological systems is necessary for the evaluation of headache. Patients who are clinically determined to have secondary headaches should undergo neuroimaging, with CT being the initial suggested study due to its affordability and ability to detect the majority of secondary headache causes [14]. Although there are signi cant radiation exposure dangers associated with CT, it is nevertheless employed for radiological diagnosis due to its accessibility, affordability, higher sensitivity, and exibility to allow for patient movement. It is well recognized that computed tomography (CT) is less sensitive than magnetic resonance imaging (MRI) for the early identi cation of certain pathologies. However, a variety of factors, including patient mobility, the longer imaging time, and the more expensive nature compared to CT have made CT the centre of emphasis for excluding particular disorders [15]. The following study contributed to the body of knowledge by nding the frequency, causes and ndings of brain Computed Tomography scan at The University of Lahore Teaching Hospital in Pakistan. The results of this study In this descriptive study, during the time period of 4-month, 202 (21.6%) of the 933 patients examined by the CT department of The University of Lahore Teaching Hospital underwent a brain CT scan. TOSHIBA Aquilion CXL 128 slices CT scanner was used. Brain CT Scan followed by proper brain CT protocols was performed on these patients. Inclusion criteria involved both genders. Patients who visited the hospital's radiology department were included in the study and underwent a physical evaluation. Patients of all age groups were included in this study. Patients with the following causes i.e., fall, RTA, vertigo, headache, nausea and vomiting, body weakness, drug abusers, loss of consciousness were included. Exclusion criteria focused on uncooperative patients and any other nding other than the brain. After the approval of synopsis, descriptive study was done at The University of Lahore Teaching Hospital, Lahore. Quantitative variables i.e., age, gender was recorded on data collection sheets. All collected data was entered in SPSS version 21.0. After determining if the patient needed a CT scan, the technologist sent the patient to the radiology department, where he or she was scanned in accordance with the CT guidelines. The data was analyzed and presented in the form of tables, pie charts and histogram.

R E S U L T S
There were 78 (38.6%) female patients and 124 (61.4%) male patients out of 202 total patients. The mean age of the patients was 47.1± 23 years. The table 1 shows that 202 (21.6 percent) of the 933 CT scans that were performed were of the brain, while the remaining 731 (78.3 percent) were of the rest of the body.

CT scan
Other CT scans  The table 2 illustrates the causes, their frequency and percentage of the Brain Computed Tomography Scans performed at University of Lahore Teaching Hospital. The table 2 also represents that 20 (9.9%) of the 202 patients had a history of falling. 17 (8.4%) out of 202 patients experienced RTA. 7 (3.5%) patients out of 202 overall patients had a history of vertigo. 23 (11.4%) had headaches. 6 (3.0%) had a history of nausea and vomiting. 15 (7.4%) patients experienced body weakness. 2 (1.0%) patients had a histor y of ver tigo while 14 (6.9%) had loss of consciousness.
The aim of our research was to determine the frequency, potential causes, and results of brain computed tomography scans at the University of Lahore Teaching Hospital. A descriptive study was done for the diagnostic purposes of the anomalies associated with the brain. Variables like age, gender, history of falls, and RTA etc. were asked about in-depth with patients who were entirely compromised. A total of 202 patients of all ages and genders who underwent CT were included in the data, including 78 (38.6%) female patients and 124 (61.4%) male patients. According to our research study, the most prevalent ndings were brain atrophy which was observed in 63 (31.2%) of the patients, 51 (25.2%) patients had infarction, 36 (17.8%) had sinusitis, 24 (11.9%) had ischemic demyelination, and 16 (7.9%) had fractures and hemorrhages. However, mastoiditis, tumors, and carcinoma were reported in 8 (4.0%) patients and other 7 patients (3.5%) had cysts. 6 patients (3.0%) reported contusions and 2 patients (1.0%) had abscesses. A study was conducted by Mebrahtu-Ghebrehiwet et al., at Orotta Hospital in Asmara, Eritrea with the aim to evaluate "the pro le of CT scan ndings in cases of severe head trauma". A total of 110 patients with acute head trauma underwent cranial CT scan between the time period of January through March 2006, along with November until December 2007 where the average age of the patients were 32.5 years old. According to radiological report, in 60 cases (54.5%), aberrant CT ndings were found, and in 50 cases, normal CT ndings (45.5 percent). The most prominent CT results were intra cerebral hemorrhages, which were found in 22% of cases and cerebral contusions or lacerations, which were found in 16% of cases. It was determined that head trauma was primarily caused by accidents involving falls [16]. In our study, falling is the second most common reason for a CT scan (9.9%), and men are more likely to need The table 3 illustrates the ndings, their frequency and percentage of the Brain Computed Tomography Scans performed at University of Lahore Teaching Hospital. The table represents that there were 202 patients in total, 16 (7.9%) of whom had fractures. Infarction was identi ed in 51 (25.2%) patients. 24 (11.9%) developed ischemia demyelination. Cyst were identi ed in 7 (3.5%) of the 202 individuals overall. 63 (31.2%) had brain atrophy. Out of 202 patients in all, 16 (7.9%) experienced hemorrhage. Sinusitis was detected in 36 (17.8%). 2 (1.0%) patients developed abscess. 8 (4.0%) had mastoiditis while contusions were identi ed in 6 (3.0%). 8 (4.0%) patients had a diagnosis of carcinoma and tumors.    nding on CT scans that contributed to the study was calci cations, which were discovered in 3.3 percent of cases. Dandy walker malformations were found in 0.02 percent of cases. 1.60 percent of people had sinusitis, 1.20 percent had big cisterna magna, and 1 percent of people showed signs of infarction. The most frequent incidental nding on CT scans that contributed to the study was calci cations, which were discovered in 3.3 percent of cases. Dandy walker malformations were found in 0.02 percent of cases. 1.60 percent of people had sinusitis, 1.20 percent had big cisterna magna, and 1 percent of people showed signs of infarction [19]. In contrast, our study showed that infarction was found in 51 (25.2%) individuals. Infarction was more prevalent in men than in women because women have estrogen and progesterone, two hormones that operate as a protective barrier for them and help to prevent infarction [20]. In a study conducted by Simpson et al., where 4404 computed tomography exams that general practitioners sought between 1999 and 2007, there was a 10.5% positive rate. Among this, 9.1 percent of total of the anomalies were believed to be coincidental in origin, while 1.4% of the CT ndings were considered to have aberrations that might be related to headaches [21]. When compared to the research we conducted, headache was the most typical reason for CT scans, accounting for 23 (11.4%) of the 202 (21.6%) patients who had a brain CT. Falls are the second-leading cause of unintended traumatic mortality over all age groups, right behind vehicle accidents [22]. According to all available data in the research conducted by Cooke et al., assaults, falls, and tra c accidents are the primary causes of brain injuries. However, there is wide regional variance, with the percentage of admissions attributable to tra c accidents ranging from 24% in Scotland to 90% in Taiwan [23]. There is further research that link head trauma from falls to brain injury with 29% present in Chicago and 30.5% in Massachusetts [24,25]. Falls have a substantial impact on the morbidity and mortality of elderly individuals. In a retrospective case study of 318 patients in Massachusetts who were 60 years of age or older, 189 (or 59%) suffered brain injuries as a result of falls [26].

D I S C U S S I O N
one. This is due to the fact that men use motor vehicles more frequently than women in Pakistan and disregard safety measures like helmet use and the most common nding was brain atrophy which was observed in 63 (31.2%) of the patients. A research study was conducted by Haghighi et al., Taba Radiology Center in Shiraz, Iran from April 2010 to August 2011. The aim of the study was to examine the frequency of anomalous results in pediatrics brain CT scans as well as the causes of requests for brain CT scans. A total of 167 children were included in this study and 84 of them were males and 83 were females that accounted for 50.3% and 49.7% respectively. The reported complains to perform head CT scan were headache in 73, head injury in 14, and seizure in 12 patients. Among 73 (60.8%) patients with headaches only 2.7% reported abnormal ndings. The most often discovered aberrant ndings included arachnoid cysts in 4 patients, cerebral hemorrhages in 3, atrophic alterations in 3 patients, hydrocephaly in 3 patients, and congenital underdevelopment in 2 patients [17]. Hemorrhage is the third most frequent nding in our study (7.9%), with subdural haemorrhage being the most frequent. Subdural bleeding originates in the veins, which is why it affects older people more commonly than younger people. Therefore, this form of haemorrhage results from the weakening of our blood vessels that occurs as we age. Additionally, our study revealed that extradural hemorrhages are more likely in men. Due to their higher risk of assault and tra c accidents, extradural bleeding occurs more frequently in men and younger people. Research was carried out by Wang et al., in Emergency Department at McMaster University, Canada from January 2004 to June 2006 in patients with age who are at least 18 years old and have not experienced trauma. The main purpose of the study was to look at computed tomography pictures to gure out the indicators of clinically signi cant atypical outcome in patients who came at emergency department of the hospital who had not suffered trauma. Out of 29469 consecutive head CT images, only 3967 were able to qualify for this research. Among them, 548 revealed clinically important abnormalities which makes 13.8%. There were 6 clinical predictors of signi cant abnormal ndings on head CT scans, with the most signi cant ones being focal neurologic de cit, changed mental status, history of malignancy, nausea/vomiting, and abnormalities in coagulation pro le [18]. In contrast, our research revealed that the most common cause to request CT scan was for the patients with headache i.e., 11.4% of the cases. In the other studies, women had a higher prevalence of headaches. However, more men than women had it in our study. Because Pakistan is an under-developed nation and its society is not very wealthy, the populace is under stress. Tension headaches result from persistent stress. Between

C O N C L U S I O N S
According to our research, the vast majority of individuals who underwent CT scans had a history of headache and falls and the most frequent observation in the patients was brain atrophy. Other major ndings found were sinusitis