Abstracts

Rationale: Brain imaging is frequently used in the evaluation of patients presenting with seizures to the emergency department (ED). As per American Academy of Neurology (AAN) guideline, there is inadequate evidence to support or refute the use of emergency CT scan of head (CTH) in adults with chronic seizure presenting to the ED but it may be useful in evaluation of adults with first seizure as it might change the management. We have conducted retrospective chart review of adult patients presenting to the ED with seizure. The goal is to look at the pattern of utilizing CTH as a tool for evaluation of patients presenting to the ED with seizure. Methods: A chart review of patients older than 18 years who presented to the ED of the University of Missouri Hospital with seizure between February 2018 and April 2018 was performed. The patient characteristics including age, gender, seizure type, precipitating factor(s), neurological examination, and CTH (if performed) were reviewed. Results: In a cohort of 78 patients, the mean age was 36 years and 61% were female. Twenty one per cent of the patients presented with first seizure – 94% of them got an emergency CTH. Seventy nine per cent of the patients had recurrent (chronic) seizures – 39% of them got an emergency CTH. Among the patients with chronic seizures, 48% had a head trauma or abnormal mental status at the time of evaluation. No new focal neurological signs were reported in any of the patients. None of the CTH were positive for acute intracranial abnormalities or findings consistent with new structural lesions. Conclusions: The key finding in this study is that obtaining emergency CTH is common in evaluation of patients presenting with seizure in the ED and patients with first seizure are more likely to get one, which is in line with the AAN guideline. No acute intracranial abnormalities were found on these scans irrespective of whether the patient presented with the first seizure or recurrent seizure. Further analysis of data in larger population of patients is necessary to understand the current practice of emergency brain imaging in patients presenting with seizure and its yield particularly in patients with chronic seizure. Funding: None