...there are easily found guidelines published by the AAN (american academy of neuro) and ACEP clinical policy on all of these (evaluation of seizure, neuroimaging of seizure)...
ACEP PolicY:
http://www.acep.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=8820
Couple of articles:
Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. Nov 20 2007;69(21):1996-2007. [Medline].
American College of Emergency Physicians. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. May 2004;43(5):605-25. [Medline].
From AAN:
Question 3:What is the likelihood that acute management for the emergency patient presenting
with a chronic seizure will be changed by the results of a neuroimaging study?
Evidence. Three Class III studies addressed this
question (table 3).2,6,15 All three studies included
patients with either chronic or first seizures and
imaging results on both types of patients within
each study are shown in table 3. These studies
included 60 to 139 patients with chronic seizures,
and 24 to 138 patients with first seizure; 12 to
25% overall had abnormal CT scans. The rates of
abnormal CT findings in patients with chronic
seizures vs a first seizure in the emergency setting
are not different, and approximately 7 to 21% of
patients with chronic seizures have abnormal imaging studies. Frequent CT abnormalities were
cerebral hemorrhages and shunt malfunctions.
However, evidence for the likelihood of an imaging study changing management for emergency
patients with chronic seizures is not available.
Conclusion. The evidence is inadequate to support or refute the usefulness of emergency CT in
persons with chronic seizures.
Recommendation. There is no recommendation
regarding an emergency CT in persons with
chronic seizures (Level U).
AAN guidelines for evaluation of Seizure
http://www.neurology.org/content/69/21/1996.full.pdf
http://www.neurology.org/content/55/5/616.full.pdf
http://www.neurology.org/content/60/2/166.full.pdf
http://www.neurology.org/content/69/18/1772.full.pdf - discusses chr Sz and neuroimaging
had a little disagreement with a neuro resident last night. without getting into the details too much, they wanted a head CT on someone we both knew would be negative. Expected plan in my mind was just d/c with outpatient follow up somewhere else for an MRI.
Usually I just get scans because I don't really care.
My attending felt very strongly about not getting the CT.
Neuro told me they wouldn't feel comfortable d/c patient home without scan.
I told them that's fine, they could just admit the patient to their service.
For some reason, they no longer cared about the CT.
