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Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town
Current international guidelines recommend that a cranial computed tomography (CT) be performed, on all HIV positive patients presenting with new onset seizures, before a lumbar puncture (LP) is performed. In the South African setting, however, this delay could be life threatening. This study sought...
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| Format: | Thesis |
| Language: | English |
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Department of Public Health and Family Medicine
2015
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| _version_ | 1867613213339680768 |
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| access_status_str | Open Access |
| author | Moolla, Salma Abdulkadir |
| author2 | De Vries, Elma |
| author_browse | De Vries, Elma Moolla, Salma Abdulkadir |
| author_facet | De Vries, Elma Moolla, Salma Abdulkadir |
| author_sort | Moolla, Salma Abdulkadir |
| collection | Thesis |
| description | Current international guidelines recommend that a cranial computed tomography (CT) be performed, on all HIV positive patients presenting with new onset seizures, before a lumbar puncture (LP) is performed. In the South African setting, however, this delay could be life threatening. This study sought to measure the number of cranial CTs that contraindicate an LP and to predict which clinical signs and symptoms are likely to pose an increased risk from LP. Methods: The study was performed at a district level hospital in the Western Cape. Data was collected retrospectively from October 2013 to October 2014. Associations between categorical variables were analysed using Pearson's Chi-squared test. Generalised linear regression was used to estimate prevalence ratios. Results 100 out of 132 patients were studied. Brain shift contraindicated an LP in 5% of patients. Patients with brain shift presented with: decreased level of consciousness, focal signs, head ache and neck stiffness. 25% of patients had a space occupying lesion (defined as a discreet lesion that has a measurable volume) or cerebral oedema. Multivariate analysis showed a CD4 count < 50 (p=0.033) to be a statistically significant predictor of patients with a space occupying lesion (SOL) and cerebral oedema. Univariate analysis showed focal signs (p=0.0001), neck stiffness (p=0.05), vomiting (p=0.018) and a GCS<15 (0.002) to be predictors of SOL and cerebral oedema. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/14259 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:34.479Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2015 |
| publishDateRange | 2015 |
| publishDateSort | 2015 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/14259 Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town Moolla, Salma Abdulkadir De Vries, Elma Rajkumar, Ashmitha Family Medicine Current international guidelines recommend that a cranial computed tomography (CT) be performed, on all HIV positive patients presenting with new onset seizures, before a lumbar puncture (LP) is performed. In the South African setting, however, this delay could be life threatening. This study sought to measure the number of cranial CTs that contraindicate an LP and to predict which clinical signs and symptoms are likely to pose an increased risk from LP. Methods: The study was performed at a district level hospital in the Western Cape. Data was collected retrospectively from October 2013 to October 2014. Associations between categorical variables were analysed using Pearson's Chi-squared test. Generalised linear regression was used to estimate prevalence ratios. Results 100 out of 132 patients were studied. Brain shift contraindicated an LP in 5% of patients. Patients with brain shift presented with: decreased level of consciousness, focal signs, head ache and neck stiffness. 25% of patients had a space occupying lesion (defined as a discreet lesion that has a measurable volume) or cerebral oedema. Multivariate analysis showed a CD4 count < 50 (p=0.033) to be a statistically significant predictor of patients with a space occupying lesion (SOL) and cerebral oedema. Univariate analysis showed focal signs (p=0.0001), neck stiffness (p=0.05), vomiting (p=0.018) and a GCS<15 (0.002) to be predictors of SOL and cerebral oedema. 2015-10-19T07:46:57Z 2015-10-19T07:46:57Z 2015 Master Thesis Masters MMed http://hdl.handle.net/11427/14259 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Family Medicine Moolla, Salma Abdulkadir Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town |
| thesis_degree_str | Master's |
| title | Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town |
| title_full | Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town |
| title_fullStr | Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town |
| title_full_unstemmed | Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town |
| title_short | Routine cranial CT before lumbar puncture in HIV positive adults presenting with seizures at Mitchells Plain Hospital in Cape Town |
| title_sort | routine cranial ct before lumbar puncture in hiv positive adults presenting with seizures at mitchells plain hospital in cape town |
| topic | Family Medicine |
| url | http://hdl.handle.net/11427/14259 |
| work_keys_str_mv | AT moollasalmaabdulkadir routinecranialctbeforelumbarpunctureinhivpositiveadultspresentingwithseizuresatmitchellsplainhospitalincapetown |