Radiology at MSc Diagnostic Imagin” rel=”nofollow”>ing with. Word counts should be not more than 3000.Would you please follow the guidelin” rel=”nofollow”>ines to avoid resit again” rel=”nofollow”>in . Moreover, I am goin” rel=”nofollow”>ing to upload the feedback of the module leader to have more in” rel=”nofollow”>information about the poin” rel=”nofollow”>ints which should be follow to prepare a successful coursework. Accordin” rel=”nofollow”>ing to the poster ,

Introduction :
This discussion study explores a radiological diagnosis of epilepsy based on a fictitious case of Mr Joshua who comes from a family with a history of epilepsy. This paper will provide a critical analysis of the diagnostic value, benefits and limitations of imagin” rel=”nofollow”>ing modalities for diagnosin” rel=”nofollow”>ing epilepsy.
Background :
Mr Joshua is 26 years old. For the last two years he has experienced varyin” rel=”nofollow”>ing in” rel=”nofollow”>incidences of seizure, in” rel=”nofollow”>includin” rel=”nofollow”>ing confusion and starin” rel=”nofollow”>ing spells. On a few occasions, he lost consciousness. He has been admitted in” rel=”nofollow”>in the past. Mostly Joshua has been visited by the family doctor who advised him to see an epilepsy specialist.

Epilepsy
Aetiology :
Epilepsy is a disorder that causes the brain” rel=”nofollow”>in to signal abnormally (Fisher, 2014). Human brain” rel=”nofollow”>ins have neurons which function in” rel=”nofollow”>in impulse generation. Each impulse acts on muscles and glands to trigger human action, feelin” rel=”nofollow”>ings and thoughts (Mayo Clin” rel=”nofollow”>inic, 2013). In epilepsy, the neuronal activities are affected or disturbed, resultin” rel=”nofollow”>ing in” rel=”nofollow”>in strange sensations and emotions, loss of consciousness, muscles spasms and sometimes convulsions. Epilepsy has a prevalence rate of 49 per 100,000 population.

Epilepsy can be traced to numerous possible causes. Some are a result of genetic in” rel=”nofollow”>influence and can be determin” rel=”nofollow”>ined by the part of the brain” rel=”nofollow”>in affected and the type of seizure experienced (De Cocker et al, 2012). Several genes are tied to epilepsy with some actin” rel=”nofollow”>ing as a trigger to in” rel=”nofollow”>induce conditions that cause seizures.

Accordin” rel=”nofollow”>ing to Shorvon, S.D. (2011) epilepsy has other causes such as:
1 . Head trauma such as accidental in” rel=”nofollow”>injury.
2 . Tumours and stroke.
3 . Infectious diseases such as menin” rel=”nofollow”>ingitis, acquired immunodeficiency syndrome (AIDS) and viral
encephalitis.
4 . Prenatal in” rel=”nofollow”>injury where the foetus is affected by poor maternal nutrition or oxygen deficiency.
5. Developmental disorders associated with autism and neurofibromatosis.

The risk of epilepsy is higher in” rel=”nofollow”>in people who are aged more than 60 years or who have a history of head in” rel=”nofollow”>injury, stroke or vascular diseases, adult dementia, brain” rel=”nofollow”>in in” rel=”nofollow”>infections such as menin” rel=”nofollow”>ingitis, seizures in” rel=”nofollow”>in childhood, and family with epilepsy (Medicin” rel=”nofollow”>ineNet, 2014).
Diagnosis :
Diagnosis of epilepsy is complex because the behavioural changes can be caused by other disorders with similar symptoms. Several tests can be used to in” rel=”nofollow”>investigate the possible causes (Benbadis, 2009). Doctors can request blood tests for in” rel=”nofollow”>infection, genetic conditions and others.
The doctor can also perform a neurological examin” rel=”nofollow”>ination aimed at testin” rel=”nofollow”>ing behaviour, mental function and abilities(Jones-Gotman et al., 2010).
In this case we are concerned with radiological techniques used to diagnose epilepsy, such as computed tomography (CT) scannin” rel=”nofollow”>ing and magnetic resonance imagin” rel=”nofollow”>ing (MRI) (Hartman et al, 2015) .
Others in” rel=”nofollow”>include electroencephalogram (EEG), functional MRI, positron emission tomography (PET) scannin” rel=”nofollow”>ing, and sin” rel=”nofollow”>ingle-photon emission computerized tomography (SPECT).
SPECT is never a primary test and is normally carried out after other tests such as MRI and EEG have failed to locate the position of the lesion. Accordin” rel=”nofollow”>ing to (Reynolds, 2002) SPECT is carried out by in” rel=”nofollow”>injection of a radioactive element in” rel=”nofollow”>into the patient’s vein” rel=”nofollow”>in to help with 3D mappin” rel=”nofollow”>ing of blood flow in” rel=”nofollow”>in the patient’s brain” rel=”nofollow”>in durin” rel=”nofollow”>ing a seizure.
CT scan :
CT scan is more common and much faster than MRI. Therefore, most emergency patients with suspected epilepsy are referred for a CT scan so that the doctor can take a close look at their brain” rel=”nofollow”>in (Schachar et al, 2011). CT scannin” rel=”nofollow”>ing provides relatively good imagin” rel=”nofollow”>ing and is simpler to use (Al-Rawi et al, 2012). However, CT scans are not as detailed as MRI images and that affects the ability of the doctor to detect epilepsy (Gaillard, et al, 2009). At times, CT scannin” rel=”nofollow”>ing is chosen to avoid anaesthetic, for example, if the patient has a heart condition.

CT scannin” rel=”nofollow”>ing uses x-rays to take brain” rel=”nofollow”>in images that can be in” rel=”nofollow”>interpreted by the doctor (Panayiotopoulos, 2005). CT scan should be avoided durin” rel=”nofollow”>ing pregnancy due to the detrimental effect that x-rays can have on the foetus ( Solomou,Papadakis and Damilakis,2014).

CT scannin” rel=”nofollow”>ing is used to check for conditions such as bone damage, in” rel=”nofollow”>internal organ in” rel=”nofollow”>injuries, blood flow complications and diseases such as cancers and stroke. In other cases, it is used to fin” rel=”nofollow”>ind the location, size and shape of a tumour, and at times it used to monitor the tumor condition (Miles, 2003).
CT scans have the advantage of bein” rel=”nofollow”>ing quick, pain” rel=”nofollow”>inless and generally safe unless the patient is experiencin” rel=”nofollow”>ing an allergic reaction (Redberg, 2009). They are safe because they are designed to min” rel=”nofollow”>inimize the level of X-ray exposure, and can be repeated many times without exposin” rel=”nofollow”>ing the patient to harmful amounts of radiation( Rastogi, Lee & Salamon, 2015). CT is therefore a good method for detectin” rel=”nofollow”>ing brain” rel=”nofollow”>in abnormalities such as in” rel=”nofollow”>infarction, lesion and underlyin” rel=”nofollow”>ing calcification (McVerry et al.,2014).
Magnetic resonance imagin” rel=”nofollow”>ing :
Magnetic resonance imagin” rel=”nofollow”>ing (MRI), though not commonly used compared to CT scan, gives better and clearer images. MRI uses strong magnetic fields and has better technical capability of showin” rel=”nofollow”>ing the detailed structure of the brain” rel=”nofollow”>in (Ahsan, 2013). The multimodal imagin” rel=”nofollow”>ing capability of MRI allows an in” rel=”nofollow”>increased chance of detectin” rel=”nofollow”>ing epilepsy by enhancin” rel=”nofollow”>ing images of the anatomical and pathological changes in” rel=”nofollow”>in the brain” rel=”nofollow”>in. Therefore, the test may be done if CT scan fails to in” rel=”nofollow”>indicate the size and location of the brain” rel=”nofollow”>in defect (Win” rel=”nofollow”>inston et al., 2013).
MRI is preferred for patients who develop epilepsy before the age of two years or after adulthood, when the epilepsy might have been triggered by brain” rel=”nofollow”>in in” rel=”nofollow”>injury, or when the patient contin” rel=”nofollow”>inues to experience seizures after takin” rel=”nofollow”>ing epilepsy medicin” rel=”nofollow”>ine (Rugg-Gunn, 2014; Ahsan, 2013). MRI is the better option in” rel=”nofollow”>in a diagnostic role due to the amount and quality of morphological in” rel=”nofollow”>information it gives, and its ability to show cerebral blood flow (Peng et al., 2015).
MRI defin” rel=”nofollow”>ines key areas of the brain” rel=”nofollow”>in sin” rel=”nofollow”>ince MR spectroscopy give much needed metabolic in” rel=”nofollow”>information (Antoch & Bockisch, 2009). MRI is able to detect epilepsy-related abnormalities such as hippocampus sclerosis, cortical malformations, vascular malformation, tumours, and acquired cortical damage (Rugg-Gunn, 2014).
Patients with metallic implants cannot undergo MRI due to possible fatal in” rel=”nofollow”>interaction between the MR signal and the metallic implant (Hussein” rel=”nofollow”>in et al, 2014; Porres et al, 2009).
Skull scannin” rel=”nofollow”>ing is one area where CT scans are preferable to MRI because MRI is not able to show the bones of the skull or calcification ( Raut,Naphade and Chawla,2012).
Once structural imagin” rel=”nofollow”>ing is enhanced through MRI, the seizure focus can be located based on lateralisation techniques (Lai et al, 2010). To complement the available in” rel=”nofollow”>information, health experts can use methods such as radionuclide imagin” rel=”nofollow”>ing or advanced MRI in” rel=”nofollow”>in case of nonconcordant structural MRI fin” rel=”nofollow”>indin” rel=”nofollow”>ings ( Abraham and Feng,2011).
Treatment options and prognosis :
Treatment of epilepsy can take different directions dependin” rel=”nofollow”>ing on the patient condition (Scott et al, 2001). The treatment processes available are medication, surgery and therapy. Some patients react well to anti-epileptic medication and can have a reduced frequency of seizures or become seizure-free (Karceski et al, 2001) . Patients may experience side effects such as weight gain” rel=”nofollow”>in, skin” rel=”nofollow”>in rashes, loss of bone density, and memory and speech problems. Potential severe side effects in” rel=”nofollow”>include severe rash, organ in” rel=”nofollow”>inflammation, depression, and suicidal thought ( Cross,2010).

In cases where the seizure source is small and located in” rel=”nofollow”>in an area that does not in” rel=”nofollow”>interfere with vital functions such as speech or vision, surgery can be performed ( De Tisi et al., 2011).

When the affected part cannot be removed, a surgery called multiple subpial transection may be carried out to hin” rel=”nofollow”>inder spreadin” rel=”nofollow”>ing to other brain” rel=”nofollow”>in parts. However, the surgery is risky and might permanently in” rel=”nofollow”>interfere with cognitive ( Downes et al., 2015).
Therapy is another method of controllin” rel=”nofollow”>ing epilepsy. The patient can be exposed to a ketogenic diet which is low in” rel=”nofollow”>in carbohydrate and high in” rel=”nofollow”>in fat. This is main” rel=”nofollow”>inly applicable in” rel=”nofollow”>in children ( Klein” rel=”nofollow”>in et al., 2010). Another therapeutic option is vagus nerve stimulation, where a battery-powered stimulator is in” rel=”nofollow”>inserted beneath the skin” rel=”nofollow”>in near the chest and sends electrical signals through the vagus nerve to the brain” rel=”nofollow”>in. This method reduces seizures by 20 to 40 percentage ( Lagae and Arzimanoglou,2015).

Case presentation and analysis :
Mr Joshua had experienced a series of partial seizures which were accompanied by a loss of consciousness. He met with the family doctor to seek further physical examin” rel=”nofollow”>ination to determin” rel=”nofollow”>ine his mental and neurological condition which, accordin” rel=”nofollow”>ing to his doctor, was a problem along his family lin” rel=”nofollow”>ine. As the personal doctor reiterated, Joshua had not previously been diagnosed with epilepsy and experienced the first partial seizure and mild loss of consciousness after his 24th birthday. Based on the family history, the series of mild seizures, and the loss of consciousness in” rel=”nofollow”>in the last two years and the last few hours, his personal doctor suspected emergin” rel=”nofollow”>ing epilepsy and recommended that Mr Joshua undergo further in” rel=”nofollow”>investigation. At the hospital, the attendin” rel=”nofollow”>ing general physician recommended that Mr Joshua immediately go for a CT scan to evaluate his brain” rel=”nofollow”>in condition.

CT scan was chosen because it was readily available and safe. Further, Mr Joshua was undergoin” rel=”nofollow”>ing his first head scan, and accordin” rel=”nofollow”>ing to the National Institute for Health and Care Excellence ( NICE) guidelin” rel=”nofollow”>ines, CT scan is recommended as an in” rel=”nofollow”>initial evaluation technique for patients suspected of neurological problems (Cohen, Klein” rel=”nofollow”>in & Mukundan, 2010) . The CT scan image did not give a conclusive result but in” rel=”nofollow”>indicated a possible lesion on the left hemisphere. After a discussion between Mr Joshua, his personal doctor and the attendin” rel=”nofollow”>ing general physician, Mr Joshua was put through contrast-enhanced CT, which confirmed Mr Joshua had a brain” rel=”nofollow”>in lesion on the left hemisphere which might have caused epilepsy. The general physician recommended that Mr Joshua visit a neuroradiologist to carry out further examin” rel=”nofollow”>ination to help confirm the type of epilepsy. In lin” rel=”nofollow”>ine with NICE guidelin” rel=”nofollow”>ines, the neuroradiologist recommended that Mr Joshua undergo an MRI scan to accurately locate the position and condition of the brain” rel=”nofollow”>in lesion (Rastogi, Lee & Salamon, 2015).
Accordin” rel=”nofollow”>ing to NICE guidelin” rel=”nofollow”>ines, Mr Joshua had to be taken through prelimin” rel=”nofollow”>inary MRI screenin” rel=”nofollow”>ing to determin” rel=”nofollow”>ine his readin” rel=”nofollow”>iness for the examin” rel=”nofollow”>ination. The purpose of prelimin” rel=”nofollow”>inary MRI screenin” rel=”nofollow”>ing is to ensure that the patient is clear of any in” rel=”nofollow”>internal biomedical implants such as cardiac pacemakers which might react fatally with the MRI signals and impede the safety of the patient (Kaprelyan, Min” rel=”nofollow”>inchev & Tzoukeva, 2012). Mr Joshua had never had any implant. The screenin” rel=”nofollow”>ing was positive, and he was to have further tests carried out, such as T1- and T2-weighted MRI before and after in” rel=”nofollow”>intravenous in” rel=”nofollow”>injection of 1 mmol/kg gadolin” rel=”nofollow”>inium diethylene triamin” rel=”nofollow”>ine pentaacetic acid (Gd-DTPA) contrast agent ( Taheri et al., 2011).

MRI is important in” rel=”nofollow”>in neuroimagin” rel=”nofollow”>ing and can help show the localization and lateralization of the seizure foci( Jansen et al., 2009). MRI gives high resolution images to enhance clarity (Henry, 2015). Mr. Joshua’s MRI in” rel=”nofollow”>indicated reduced hippocampus volume, slight alteration in” rel=”nofollow”>in in” rel=”nofollow”>inner brain” rel=”nofollow”>in structure and loss of differentiation between the grey and white matter of the brain” rel=”nofollow”>in. The MRI showed an image of a sharply margin” rel=”nofollow”>inated but non-enhanced hypoin” rel=”nofollow”>intense lesion on the left in” rel=”nofollow”>insular cistern.
Mr Joshua was diagnosed with refractory epilepsy that is common in” rel=”nofollow”>in patients with structural brain” rel=”nofollow”>in lesions( Kaprelyan, Min” rel=”nofollow”>inchev and Tzoukeva,2012). The neurologist recommended that Mr Joshua be put on anti-epileptic drugs (AEDs), his condition be closely monitored, and he begin” rel=”nofollow”>in therapy.

Conclusion :
Mr Joshua was diagnosed with refractory epilepsy. Given the location and the spread of the lesion, the neuroradiologist and neurosurgeons ruled out surgery and recommended Mr Joshua be put on a series of AEDs and that his condition be closely monitored to ensure he was receivin” rel=”nofollow”>ing the right medication. Mr Joshua was to revisit the neurologist after six months.

References
Abraham, T. & Feng, J. 2011, “Evolution of Brain” rel=”nofollow”>in Imagin” rel=”nofollow”>ing Instrumentation”,Semin” rel=”nofollow”>inars in” rel=”nofollow”>in Nuclear Medicin” rel=”nofollow”>ine, vol. 41, no. 3, pp. 202-219.
Ahsan,H.(2013). University of Rochester Medical Center Radiology. [onlin” rel=”nofollow”>ine] Available at: https://www.urmc.rochester.edu/medialiraries/urmcmedia/imagin” rel=”nofollow”>ing/education/eductional-resources/documents/epilepsy.pdf [Accessed on 25 December 2015].
Antioch, G. & Bockisch, A. (2009). Combin” rel=”nofollow”>ined PET/MRI: a new dimension in” rel=”nofollow”>in whole-body oncology imagin” rel=”nofollow”>ing? European Journal of Nuclear Medicin” rel=”nofollow”>ine and Molecular Imagin” rel=”nofollow”>ing. Vol. 36, number 1, pp. 113-120.
Al-Rawai, M., Mohammed, A., Saeed, F,. Ahmed, S., & Mutter,A. (2012). The role of CT scan in” rel=”nofollow”>in the diagnosis of epilepsy. Academia. Retrived from : http://www.academia.edu/1998988/The role of CT scan in” rel=”nofollow”>in the diagnosis of epilepsy [Accessed on 2 December 2015].

Benbadis, S. (2009). The differential diagnosis of epilepsy: a critical review. Epilepsy & Behavior, Vol. 15, number 1, pp. 15-21.

Cohen, A.B., Klein” rel=”nofollow”>in, J.P. & Mukundan, S. (2010). A guide to imagin” rel=”nofollow”>ing for common neurological problems. British Medical Journal. Vol. 341, number 7769, pp. 388-393. Available from: DOI 10.1136/bmj.c4113.

Cross, J.H. 2010, “Neurodevelopmental effects of anti-epileptic drugs”, Epilepsy Research, vol. 88, no. 1, pp. 1-10.

De Cocker, L., D’Arco, F., Demaerel, P., & Smithuis, R. (2012). The radiology assistant: Role of MRI in” rel=”nofollow”>in epilepsy. Radiology Assistant. Retrieved from http://www.radiologyassistant.nl/en/p4f53597deae16/role-of-mri-in” rel=”nofollow”>in-epilepsy.html [Accessed on 12 December 2015].
Downes, M., Greenaway, R., Clark, M., Helen Cross, J., Jolleff, N., Harkness, W., Kaliakatsos, M., Boyd, S., White, S. & Neville, B.G.R. 2015, “Outcome followin” rel=”nofollow”>ing multiple subpial transection in” rel=”nofollow”>in Landau-Kleffner syndrome and related regression”, Epilepsia, vol. 56, no. 11, pp. 1760-1766.

Fisher, R.S., Acevedo, C., Arzimanoglou, A., Bogacz, A., Cross, J.H., Elger, C.E., Engel, J., Forsgren, L., French, J.A., Glynn, M., Hesdorffer, D.C., Lee, B.I., Mathern, G.W., Moshé, S.L., Perucca, E., Scheffer, I.E., Tomson, T., Watanabe, M., Wiebe, S. (2014). ILAE Official Report: A practical clin” rel=”nofollow”>inical defin” rel=”nofollow”>inition of epilepsy. Epilepsia, Vol. 55, number 4, pp. 475-482.
Gaillard, W.D., Chiron, C., Helen Cross, J., Simon Harvey, A., Kuzniecky, R., Hertz-Pannier, L. and Gilbert Vezin” rel=”nofollow”>ina, L., 2009. Guidelin” rel=”nofollow”>ines for imagin” rel=”nofollow”>ing in” rel=”nofollow”>infants and children with recent-onset epilepsy. Epilepsia, Vol. 50, number 9, pp. 2147-2153.

Hartman, L.A., Nace, S.R., Maksimovic, J.H., Rusin” rel=”nofollow”>inak, D. & Rowley, H.A. 2015, “Epilepsy imagin” rel=”nofollow”>ing: Approaches and protocols”, Applied Radiology, vol. 44, no. 5, pp. 8.

Henry, T. (2015) Seizures and epilepsy: Structural brain” rel=”nofollow”>in imagin” rel=”nofollow”>ing in” rel=”nofollow”>in chronic epilepsies. Epilepsy Board Review Manual. Vol. 4, number 2, pp. 2-4. Available from http://www.turner-white.com/pdf/brm_EPI_pre1_3.pdf. [Accessed on 27 December 2015].

Hussein” rel=”nofollow”>in, A.A., Abutaleb, A., Jeudy, J., Phelan, T., Patel, R., Shkullaku, M., Siddiqi, F., See, V., Saliaris, A., Shorofsky, S.R. & Dickfeld, T. 2014, “Safety of computed tomography in” rel=”nofollow”>in patients with cardiac rhythm management devices: assessment of the U.S. Food and Drug Admin” rel=”nofollow”>inistration advisory in” rel=”nofollow”>in clin” rel=”nofollow”>inical practice”, Journal of the American College of Cardiology, vol. 63, no. 17, pp. 1769.

Jansen, A., Sehlmeyer, C., Pfleiderer, B., Sommer, J., Konrad, C., Zwitserlood, P. & Knecht, S. 2009, “Assessment of verbal memory by fMRI: Lateralization and functional neuroanatomy”, Clin” rel=”nofollow”>inical Neurology and Neurosurgery, vol. 111, no. 1, pp. 57-62.

Jones-Gotman, M., Smith, M.L., Risse, G.L., Westerveld, M., Swanson, S.J., Giovagnoli, A.R., Lee, T., Mader-Joaquim, M.J. & Piazzin” rel=”nofollow”>ini, A. 2010, “The contribution of neuropsychology to diagnostic assessment in” rel=”nofollow”>in epilepsy”,Epilepsy and Behavior, vol. 18, no. 1, pp. 3-12.

Karceski, S., Morrell, M. & Carpenter, D. (2001). The expert consensus guidelin” rel=”nofollow”>ine series: treatment of epilepsy. Epilepsy & Behavior, Vol. 2, number 6, pp. A1-A50.

Kaprelyan, A., Min” rel=”nofollow”>inchev, D., & Tzoukeva, A. (2012). Use of structural MRI in” rel=”nofollow”>in patients with medically refractory seizures. Journal of International Medical Association Bulgaria , Vol. 18, number 3, 253-256. http://dx.doi.org/10.5272/jimab.2012183.353

Lagae, L. & Arzimanoglou, A. 2015, “In response: Vagus nerve stimulation for epilepsy treatment in” rel=”nofollow”>in children”, Epilepsia, vol. 56, no. 2, pp. 324-325.

Lai, V., Mak, H., Yung, A., Ho, W., & Hung, K. (2015). Neuroimagin” rel=”nofollow”>ing techniques in” rel=”nofollow”>in epilepsy.Hong Kong Medical Journal. Vol. 6, number 4, pp. 4-26. Retrieved from http://www.hkmj.org/system/files/hkm1008p292.pdf [Accessed on 27 December 2015]

Mayo Clin” rel=”nofollow”>inic (2013). Symptoms and causes – Epilepsy. Retrieved from http://www.mayoclin” rel=”nofollow”>inic.org/diseases-conditions/epilepsy/symptoms-causes/dxc-20117207 [Accessed on 21 December 2015].
McVerry, F., Dani, K.A., MacDougall, N.J.J., MacLeod, M.J., Wardlaw, J. & Muir, K.W. 2014, “Derivation and Evaluation of Thresholds for Core and Tissue at Risk of Infarction Usin” rel=”nofollow”>ing CT Perfusion”, Journal of Neuroimagin” rel=”nofollow”>ing, vol. 24, no. 6, pp. 562-568.

Medicin” rel=”nofollow”>ineNet (2014). Seizure (Epilepsy) Symptoms, Causes, Treatment – Introduction. Retrieved from http://www.medicin” rel=”nofollow”>inenet.com/seizure/page2.htm [Accessed on 27 December 2015]
Miles, K.A.( 2003). “Functional CT imagin” rel=”nofollow”>ing in” rel=”nofollow”>in oncology”, European Radiology, vol. 13, no. S5, pp. 134-138.

Panayiotopoulos, C. (2005). Brain” rel=”nofollow”>in Imagin” rel=”nofollow”>ing in” rel=”nofollow”>in the Diagnosis and Management of Epilepsies. Bladon Medical Publishin” rel=”nofollow”>ing. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2602/[Accessed on 22 December 2015].

Peng, S., Su, P., Wang, F., Cao, Y., Zhang, R., Lu, H. & Liu, P. 2015, “Optimization of phase-contrast MRI for the quantification of whole-brain” rel=”nofollow”>in cerebral blood flow”, Journal of Magnetic Resonance Imagin” rel=”nofollow”>ing, vol. 42, no. 4, pp. 1126-1133.

Porres , J. M., Cerezuela, J. L., Luque, O., & Marco, P. (2009) Computed tomography scan and ICD in” rel=”nofollow”>interaction, Case Reports in” rel=”nofollow”>in Medicin” rel=”nofollow”>ine, Vol. 2009. DOI: 10.1155/2009/189429.
Rastogi, S., Lee, C., & Salamon, N. (2015). Neuroimagin” rel=”nofollow”>ing in” rel=”nofollow”>in pediatric epilepsy: A multimodality approach, Radiographics, Vol. 6, number 3, pp. 6-34. Retrieved from http://pubs.rsna.org/doi/pdf/10.1148/rg.284075114 [Accessed on 26 December 2015].

Raut, A.A., Naphade, P.S. & Chawla, A. 2012, “Imagin” rel=”nofollow”>ing of skull base: Pictorial essay”, The Indian journal of radiology & imagin” rel=”nofollow”>ing, vol. 22, no. 4, pp. 305-316.

Redberg, R.F. (2009). Cancer risks and radiation exposure from computed tomographic scans: How can we be sure that the benefits outweigh the risks? Archives of Internal Medicin” rel=”nofollow”>ine. Vol. 169, number 22, pp. 2049-2050.
Reynolds, E. (2002). Epilepsy the disorder. Epilepsy Atlas. Retrieved from http://www.who.in” rel=”nofollow”>int/mental_health/neurology/Epilepsy_disorder_rev1.pdf [Accessed on 26 December 2015].
Rogovik, A.L. & Goldman, R.D. 2010, “Ketogenic diet for treatment of epilepsy”,Canadian Family Physician, vol. 56, no. 6, pp. 540-542.

Rugg-Gunn, F. (2014). Neuroimagin” rel=”nofollow”>ing of the epilepsies. Department of Clin” rel=”nofollow”>inical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, Queen Square, London. Retrieved from http://www.ilae.org/visitors/centre/Documents/OrganizationEpilepsy.pdf [Accessed on 23 December 2015].

Schachar, J.L., Zampolin” rel=”nofollow”>in, R.L., Miller, T.S., Farin” rel=”nofollow”>inhas, J.M., Freeman, K. and Taragin” rel=”nofollow”>in, B.H., 2011. External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scannin” rel=”nofollow”>ing in” rel=”nofollow”>in pediatric patients with min” rel=”nofollow”>inor head in” rel=”nofollow”>injury in” rel=”nofollow”>in a non-trauma center. Pediatric radiology,41(8), pp.971-979.

Scott, R.A., Lhatoo, S.D. & Sander, J.W. (2001). The treatment of epilepsy in” rel=”nofollow”>in developin” rel=”nofollow”>ing countries: where do we go from here? Bulletin” rel=”nofollow”>in of the World Health Organization, Vol. 79, number 4, pp. 344-351.

Shorvon, S.D. (2011). The causes of epilepsy: Changin” rel=”nofollow”>ing concepts of etiology of epilepsy over the past 150 years. Epilepsia, Vol. 52, number 6, pp. 1033-1044.

Solomou, G., Papadakis, A.E. & Damilakis, J. 2015, “Abdomin” rel=”nofollow”>inal CT durin” rel=”nofollow”>ing pregnancy: a phantom study on the effect of patient centrin” rel=”nofollow”>ing on conceptus radiation dose and image quality”, European Radiology, vol. 25, no. 4, pp. 911-921.

Taheri, S., Gasparovic, C., Shah, N.J. & Rosenberg, G.A. 2011, “Quantitative measurement of blood-brain” rel=”nofollow”>in barrier permeability in” rel=”nofollow”>in human usin” rel=”nofollow”>ing dynamic contrast-enhanced MRI with fast T1 mappin” rel=”nofollow”>ing”, Magnetic Resonance in” rel=”nofollow”>in Medicin” rel=”nofollow”>ine, vol. 65, no. 4, pp. 1036-1042.

Win” rel=”nofollow”>inston, G.P., Micallef, C., Kendell, B.E., Bartlett, P.A., Williams, E.J., Burdett, J.L. & Duncan, J.S. 2013, “The value of repeat neuroimagin” rel=”nofollow”>ing for epilepsy at a tertiary referral centre: 16 years of experience”, Epilepsy research, vol. 105, no. 3, pp. 349-355.

Appendices :
Appendix 1
Fig 1: Magnetic resonance image of 17 years old Boy sufferin” rel=”nofollow”>ing from temporal lobe epilepsy

Source (Lai, Mak, Yung, Ho & Hung, 2015)

Appendix 2
Fig 2: MRI showin” rel=”nofollow”>ing Tuberous sclerosis of a patient sufferin” rel=”nofollow”>ing from multiple cortical and sub cortical supratentorial lesions (tubers)

Source (Kaprelyan, Min” rel=”nofollow”>inchev & Tzoukeva, 2012)
Appendix 3
Fig 3: MRI imagin” rel=”nofollow”>ing of the brain” rel=”nofollow”>in

Source (Rugg-Gunn, 2014)