Emergency computed tomography in patients with first seizure

Kotisaari, K.; Virtanen, Pekka; Forss, Nina; Strbian, Daniel; Scheperjans, Filip

doi:10.1016/j.seizure.2017.04.009

Cited by 24 publications

(16 citation statements)

References 15 publications

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“…Positive CTB findings ranged from 12% to 41% in other studies. (15,22) The higher yield in our study suggests the need to perform a CTB in all first-episode seizure patients with no obvious extracranial cause of the seizure.…”

Section: Discussionmentioning

confidence: 71%

A Cross-sectional Descriptive Study of Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Neonates

Sofola-Orukotan¹,

Motara²,

Bentley³

et al. 2019

Wits Journal of Clinical Medicine

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Background: First-onset seizures are not a diagnosis per se but may be a harbinger of a potentially life-threatening underlying illness. The aim of this pilot study was to describe the pattern of presentation of adults presenting with a first-onset seizure to the emergency department (ED). Methods: Medical records of patients >18 years who presented over a 6-month period (November 2016 to May 2017) to the study centre with a first-episode seizure were retrospectively reviewed. Results: A total of 60 patients, with a median age of 37.4 years (IQR; 29.3-47.7 years) presented with first-onset seizures over the study period. The median time to ED presentation after a seizure episode was 120 min (IQR; 51-244 min). More than half the number of subjects (58.3%) were male, 28.3% were HIV positive, 84.2% had a generalized tonic-clonic seizure and 56.7% required admission. A decrease in the level of consciousness, foaming around the mouth, tongue biting and urinary incontinence were evident in 76.7%, 36.7%, 31.7% and 33.3% of subjects, respectively. Hypoglycaemia (26.7%), ring-enhancing space occupying lesion/s (16.7%) and cerebrovascular infarction (11.7%) accounted for approximately two-thirds of causes of first-episode seizures. Long-acting anticonvulsants were administered to 66.7% of subjects in the ED and prescribed to 53.3% of subjects upon hospital discharge. Conclusion: Hypoglycaemia and intracranial pathologies are common causes of first-episode seizures that must be considered in all patients. The late presentation of patients to the ED in this pilot study is a major concern. Due to the high prevalence of HIV in South Africa, there is a need to develop local guidelines on the management of first-presentation seizures in HIV-positive as well as HIV-negative patients.

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Section: Discussionmentioning

confidence: 71%

A Cross-sectional Descriptive Study of Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Neonates

Sofola-Orukotan¹,

Motara²,

Bentley³

et al. 2019

Wits Journal of Clinical Medicine

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“…In this regard, Kotisaaari et al in 2017 performed a CT scan on 416 of the 449 patients visiting the emergency unit, among which 49 (12%) had emergent imaging findings in the CT scan. 4 de la Sayette et al, in a study on 387 patients over 50 years of age with late-onset epilepsy, reported that most patients for whom CT scan was performed had either normal results or evidence of cerebral atrophy. 9 In another study on children hospitalized due to afebrile seizure in Tehran, Iran, 90% of the CT scans were reported as normal, which is in accordance with our study.…”

Section: Discussionmentioning

confidence: 99%

“…6 In the study by Kotisaari et al, headache (odds ratio=3.62), movement symptoms (odds ratio=3.23), history of malignancy (odds ratio=3.05), unstable mental status (odds ratio=2.27) are dependent on the pathologic findings in the CT scan. 4 Therefore, one could rely on the clinical symptoms before requesting a CT scan in patients with a first-onset seizure.…”

Section: Discussionmentioning

confidence: 99%

“…1 Brain CT (computed tomography) scanning is a non-invasive method that facilitated the diagnosis of many neurologic diseases. 4 However, during CT imaging, the patient is exposed to ionizing radiation, and studies have shown that these small amounts of radiation can be accompanied by a high risk of cancer, especially in children. 5 As every CT scan is considered to be part of lifetime exposure to radiation, it is imperative to limit exposure to radiation through CT scanning.…”

Section: Introductionmentioning

confidence: 99%

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<p>Brain CT Findings in Patients with First-Onset Seizure Visiting the Emergency Department in Mashhad, Iran</p>

Zarmehri

Teimouri

Ebrahimipour

et al. 2020

OAEM

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Introduction: Regarding the complications and costs of CT imaging for patients, this study aimed at investigating the necessity of CT scans in patients visiting the emergency unit with first-onset seizure. Methods: One hundred patients who had experienced their first seizure were enrolled. Their CT scan was studied, and based on the radiology report, the type of probable pathologies and their percentage were determined. Results: The patient's mean age was 39.78±17.43 yrs. CT scan abnormalities were reported in 27 cases as follows: nonspecific senile changes in 11 (40.7%), encephalomalacia in 3 (11.1%), acute infarct in 5 (18.5%), lacunar infarct in 3 (11.1%), mass-like lesion in 4 (14.8%) and cerebral venous thrombosis (CVT) evidence in 1 (3.7%). Acute infarct and mass-like lesions were seen together in the CT scan of one patient. In only 9 of the 27 abnormal CT scans, the findings were in accordance with seizure consisting of an acute infarct, mass-like lesion, and CVT evidence. Discussion: It seems that performing a CT scan in all patients referring to the emergency department with a first-onset seizure is not necessary.

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“…Evidence supports the use of emergency computed tomography (CT) in only a subgroup of adults who present with a first seizure, where there is history of head injury, fever, immunosuppression, malignancy, focal motor or sensory onset of seizure, or where patients present with a persistently reduced level of consciousness. 5,6 This has been adopted into the UK Guidelines in Emergency Medicine Network (GEMNet) protocol on the management of first seizure in the emergency department (ED). 7 For the remainder of first seizure patients, brain imaging, usually magnetic resonance imaging (MRI), can be requested at an outpatient neurology or first seizure clinic.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography in patients with epileptic seizures admitted acutely to hospital: A population level analysis of routinely collected healthcare data

et al. 2020

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Approximately 1.4% of emergency medical admissions are due to epileptic seizures. For the majority of such cases, computed tomography (CT) will not inform acute management and is unnecessary. Pseudonymised, routinely collected data from seven hospitals within the Cheshire and Merseyside area of the UK were analysed. All patients with emergency admissions to hospital due to seizures between 2014 and 2017 were included. Use of CT of the head was identifi ed from routine coding. We identifi ed 4,183 individuals with an acute seizure admission, of which over 30% received a CT of the head. There was signifi cant variation in CT among hospital trusts. The rate of CT for patients admitted with seizures is high and CT is not being directed to those where they may be indicated. Integrated care pathways and guidelines are required to improve the management of patients presenting acutely with seizures.

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Emergency computed tomography in patients with first seizure

Abstract: In FS patients, clinical information can be used to guide imaging decisions in the ED. However, if emergency imaging is not performed, urgent outpatient imaging and pre-imaging follow up should be secured.

Cited by 24 publications

References 15 publications

A Cross-sectional Descriptive Study of Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Neonates

A Cross-sectional Descriptive Study of Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Neonates

<p>Brain CT Findings in Patients with First-Onset Seizure Visiting the Emergency Department in Mashhad, Iran</p>

Computed tomography in patients with epileptic seizures admitted acutely to hospital: A population level analysis of routinely collected healthcare data

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