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Master Thesis

Pertinence des critères cliniques dans l'indication d'une imagerie cérébrale en urgence pour une première crise d'épilepsie‎ : une étude rétrospective sur 2 ans au CHU de Grenoble

Abstract : To this date, recommendations concerning the first seizure exam rely on an etiological and prognostic blood sample test, electrocardiagram and neuroimaging. Experts are prudent regarding the period after which neuroimaging shall be performed, and thus prefer to recommend systematic imaging in emergency rooms . Clinical criteria allowing one to target patients whose neuroimaging is likely to reveal abnormalties have been studied and approved by several american experts panels in 1996. This descriptive retrospective study has been carried out from January 1, 2011, to January 5, 2013, in the emergency room of the hospital of Grenoble, France. It included 356 patients. The impact of some of the clinical criteria identified in 1996 is analyzed, such as hyperthermia, abnormal neurological examination, history of immunodeficiency, ongoing anticoagulation therapy, and age over 40 years. Among a total of 321 neuroimaging performed, 52% are abnormal: 97 strokes, 55 atrophies (most often associated with other lesions), 25 primitive tumors, 21 metastasis, 10 extradural or subdural hematoma, and 21 other lesions. One hundred and twelve patients present an abnormal neurological examination upon their arrival , and 74% of them show abnormal neuroimaging The mean time period before consultation is 9.8 days. 95% of the patients that show at least one of the analyzed clinical criteria present abnormal neuroimaging. Focal deficit, age and history of stroke are found to be key clinical criteria. However, 10.4% of the patients that don't exhibit any of the analyzed criteria all the same have abnormal neuroimaging. The first seizure department has thus an essential role to play to re-evaluate these patients, with a more adapted imaging enabling one to date lesions and to assess recurrence risks.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00904194
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Submitted on : Tuesday, September 30, 2014 - 9:31:41 AM
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  • HAL Id : dumas-00904194, version 1

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Peggy Thiebault. Pertinence des critères cliniques dans l'indication d'une imagerie cérébrale en urgence pour une première crise d'épilepsie‎ : une étude rétrospective sur 2 ans au CHU de Grenoble. Médecine humaine et pathologie. 2013. ⟨dumas-00904194⟩

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