Abstracts

Neuroimaging can be helpful to determine whether seizures result from structural abnormalities of the brain. In the ER all patients presenting with seizures are routinely sent to have CT scan of the brain.
The purpose of our study is to evaluate the yield of routine CT head in patients presenting with seizures in the ER. We identified, retrospectively through ICD code, all patients who presented to the emergency department at JFK hospital with a history of seizures between 1995-2004. All patients were grouped according to their age into [lt]20 yrs, between 20-60 and [gt]60 yrs old. The head CT findings were classified into; a) acute changes b) chronic changes and c) normal. A total of 1373 records were obtained and 300 patients who presented with seizure were eligible for analysis, however 81of them were excluded due incomplete information. There were 29 patients [lt]20 years, 180 patients between 20-60 years and 10 patients [gt]60 yrs of age. Acute changes in CT head occurred in 14 patients constituting 6.3%. Acute changes occurred in three patients age [lt]20 years (two with cerebral edema and one brain tumor), in nine patients between the age 20-60 (7 with stroke, one SDH and one brain tumor), and 2 patients [gt]60 years (both had stroke). All patients with acute CT changes had new onset focal neurological deficits. Chronic changes occurred in 29 patients between the age of 20-60 yrs, in seven patients [gt]60 yrs but in only one [lt]20 years, constituting 0.03 %. The majority of CT head obtained were normal (70.7%). In the emergency room, CT head should not be obtained routinely in patients presenting with seizures. On rare occasions, when the neurological examination is abnormal as part of acute presentation, imaging may be of value in the emergency setting.