Did you take a look at the eyeballs? What is your impression?
There is conjugate eye deviation (CED) to the left, a possible indicator of ipsilateral cortical or subcortical supratentorial pathology, subsidiary brainstem or midbrain pathology. Conjugate eye deviation may also be seen in seizures, where it may "look away" from focal pathology.
True or false: There are no abnormalities and further imaging is not necessary.
Both true and false. There are no abnormalities, especially no focal abnormalities (e.g. Rasmussen encephalitis), to explain the clinical picture. However, further imaging IS warranted.
True or false: The next step in patient management is MRI.
True. MRI is the imaging modality of choice to depict brain abnormalities, be they focal or disseminated, owing to its superior soft-tissue contrast, inter alia. Imaging in the pediatric population invariably requires deep sedation or even general anesthesia, which is why imaging is often performed in a subacute setting.
Non-contrast CT performed acutely reveals no abnormalities.
There is preservation of grey white matter interface. There is no dense MCA (MCA clot or dot sign), there is no evidence of swelling or hemorrhage.
Conjugate eye deviation to the left is noted.