Emergency brain computed tomography in children with seizures: who is most likely to benefit?
OBJECTIVE
To determine whether the recently published guidelines on neuroimaging in patients with new-onset seizures are applicable to children.


METHODS
We carried out a retrospective analysis of 107 neurologically normal children (excluding children with simple febrile seizures) who had undergone neuroimaging when they presented to the emergency department with a possible "first seizure."


RESULTS
Eight of the 107 children had nonepileptic events (gastroesophageal reflux, syncopal event, rigor). Of the remaining 99 children, 49 had provoked seizures (complicated febrile seizure, meningo-encephalitis, toxic or metabolic abnormalities), and 50 had unprovoked seizures. A total of 19 children had brain abnormalities identified on computed tomography (CT) scan; 7 received further investigation or intervention as a result of CT scan findings (2 with tumors, 3 with vascular anomalies, 1 with cysticercosis, and 1 with obstructive hydrocephalus). CT scan abnormalities requiring treatment or monitoring were more frequently seen in children with their first unprovoked seizure (P < .01) and in those children whose seizure onset had been focal or who had focal abnormalities identified on postictal neurologic examination (P < .04).


CONCLUSIONS
In a child, a seizure in the setting of a fever rarely indicates the presence of an unexpected CT scan lesion requiring intervention.
Garvey
M A
MA
Department of Neurology, Children's National Medical Center, Washington, DC 20010, USA.
Gaillard
W D
WD
Rusin
J A
JA
Ochsenschlager
D
D
Weinstein
S
S
Conry
J A
JA
Winkfield
D R
DR
Vezina
L G
LG
D000293:Adolescent; D001927:Brain Diseases / Q000150:complications / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004630:Emergencies; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012640:Seizures / Q000000981:diagnostic imaging* / Q000209:etiology; D003294:Seizures, Febrile / Q000000981:diagnostic imaging / Q000209:etiology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed