Investigating seizures (summary)

Last revised by Avni K P Skandhan on 27 Jul 2021
This is a basic article for medical students and other non-radiologists

Seizures are a common medical emergency and presentation to emergency departments 1-3. All new seizures or changes in seizure activity merit assessment with neurologists, and usually require neuroimaging 3,4. They can be distressing to witness for patient, families and clinicians and can be caused by a number of factors.

Reference article

This is a summary article; read more in our article on epilepsy.

  • questions
    • was the seizure focal or generalized?
    • has the patient had an EEG - what was the result?
    • any of the following?
      • new focal neurology deficits
      • persistent altered consciousness/confusion
      • fever
      • persistent headache
      • medical history (malignancy, AIDS, previous neurosurgery)
      • use of anticoagulants
  • investigations
    • CT head
      • acute presentation
        • new seizure
        • different seizure behavior
    • MRI brain
      • hasn't been previously investigated
      • change in seizure semiology
      • follow up of underlying tumor
  • making the request
    • why is imaging required?
    • what is the relative urgency?
      • why does it need to be done now?
    • what lateralizing features are there (clinical or investigations)?
  • common pathology

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Cases and figures

  • Case 1: right MCA Infarction
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  • Case 2: glioblastoma
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  • Case 3: subarachnoid hemorrhage
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  • Case 5: vagal nerve stimulator
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  • Case 4: dysembryoplastic neuroepithelial tumor
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