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Neurohospitalist. 2019 Apr;9(2):71-78. doi: 10.1177/1941874418808676. Epub 2018 Nov 18.

Yield of Emergent CT in Patients With Epilepsy Presenting With a Seizure.

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Department of Neurology, Stanford University, Stanford, CA, USA.
Department of Neurology, University of California, San Francisco, CA, USA.
Department of Emergency Medicine, University of California, San Francisco, CA, USA.



Studies of emergent neuroimaging in the management of patients presenting with a breakthrough seizure are lacking. We sought to determine how often emergent computed tomography (CT) scans are obtained in patients with known epilepsy presenting with a seizure and how often acute abnormalities are found.


This multicenter retrospective cohort study was performed in the emergency department at 2 academic medical centers. The primary outcomes were percentage of visits where a CT scan was obtained, whether CT findings represented acute abnormalities, and whether these findings changed acute management.


Of the 396 visits included, CT scans were obtained in 39%, and 8% of these scans demonstrated acute abnormalities. Patients who were older, had status epilepticus, a brain tumor, head trauma, or an abnormal examination were all significantly more likely to undergo acute neuroimaging (P < .05). In the multivariable model, only history of brain tumor (odds ratio [OR] 5.88, 95% confidence interval [CI], 1.33-26.1) and head trauma as a result of seizure (OR 3.92, 95% CI, 1.01-15.2) reached statistical significance in predicting an acutely abnormal scan. The likelihood of an acute imaging abnormality in visits for patients without a history of brain tumor or head trauma as a result of the seizure was 2.7% (2 visits). Both of these patients had abnormal neurological examinations.


Obtaining an emergent CT scan for patients with epilepsy presenting with a seizure may be avoidable in most cases, but might be indicated for patients with a history of brain tumor or head trauma as a result of seizure.


CT; computed tomography; emergency; epilepsy; seizure

[Available on 2020-04-01]

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: VCD receives compensation as Editor-in-Chief of The Neurohospitalist. SAJ receives personal compensation in his role as Editor-in-Chief of JAMA Neurology and as Associate Editor for Continuum Audio. JPB receives personal compensation for serving as web editor of JAMA Neurology. KAK reports no conflict of interest.

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