Emergency computed tomography in patients with first seizure

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• First seizure (FS) presentation to the emergency department (ED) necessitates prompt evaluation.
• Head computed tomography (CT) is frequently utilized in the workup of FS patients.
• Identifying emergent findings on head CT can significantly alter acute management.

Purpose of the Study:

• To determine the frequency of emergent head CT findings in adult first seizure patients.
• To identify clinical features associated with emergent imaging findings in this population.

Main Methods:

• Retrospective registry-based study of adult FS patients presenting to Helsinki University Hospital ED.
• Review of head CT scans by a neuroradiologist blinded to clinical data.
• Predefined emergent findings included intracranial hemorrhage, ischemia, infection, mass effect, midline shift, hydrocephalus, and edema.

Main Results:

• Of 416 FS patients who underwent head CT, 49 (12%) had emergent findings on non-contrast CT (NCCT).
• Headache, focal motor signs, history of malignancy, and altered mental state were associated with emergent findings (ORs ranging from 2.27 to 3.62).
• The presence of at least one of these clinical factors demonstrated 84% sensitivity for detecting emergent imaging findings.

Conclusions:

• Clinical information is valuable for guiding head CT decisions in the ED for first seizure patients.
• If immediate imaging is not performed, timely outpatient neuroimaging and follow-up are crucial.