A retrospective analysis of 107 neurologically normal children with emergency brain scans for new-onset seizures is reported from the Children’s National Medical Center, Washington, DC. In 8 (7%), the seizures were nonepileptic (gastroesophageal reflux, syncope, rigor). In 49 of the remaining 99, seizures were provoked (complicated febrile seizure, encephalitis, toxic or metabolic), and in 50, they were unprovoked. CT abnormalities identified in 19 required further investigation or intervention in 7 (tumors in 2, vascular anomalies in 3, cysticercosis in 1, and obstructive hydrocephalus in 1). First seizures unprovoked by fever or metabolic causes, and especially focal seizures, were most likely to have underlying pathologies demonstrated on emergency CT and requiring intervention. [1]

COMMENT. Emergency CT is indicated in a previously well child with a new-onset unprovoked seizure, especially if the seizure is focal. A first seizure with fever is unlikely to be symptomatic of an unexpected brain lesion demonstrable by CT and requiring intervention. A careful neurologic exam performed within 24 hours of the seizure, to exclude localized abnormalities and asymmetry of signs, is essential in determining the need for CT. When the history is unreliable, the neurologic signs of uncertain significance, and follow-up unavailable, a CT is advisable before the patient is discharged.