Stepping outside the box: an adolescent with a new-onset seizure

First-time seizures are frightening to children and their families, but the practice parameter recommends minimal evaluation in the emergency department (ED) for the child who presents in a neurologically normal state. We report a 12-year-old girl with seizure whose evaluation in the ED included a computed tomographic scan, largely because of parental anxiety. Computed tomography demonstrated a cerebral cavernous hemangioma or cavernoma. Because of the high recurrence risk of seizures with cavernomas, she was discharged from the ED with a prescription for an antiepileptic drug.