Brain Computed Tomography (CT) Findings in paediatric patients who present with new onset unprovoked afebrile seizures to the emergency department.

Abstract

Summary: Seizures are a common clinical problem at all ages, including in children. In the USA, it is estimated that 10% of the population will experience at least one attack of seizures in their lifetime. The role of imaging in children presenting with seizures has evolved in the last two decades due to the increasing availability of Magnetic Resonance Imaging (MRI) and a recognition of the importance of reducing the use of CT in children due to radiation risks. CT is also known to have reduced sensitivity for many conditions responsible for childhood seizures such as mesial temporal sclerosis, cortical dysplasias and small neoplasms. At our institution, CT is still used extensively in the emergency setting for children presenting with seizures. It is important to investigate this practice to ensure the benefits outweigh the risks. American Academy of Radiology guidelines recommend the use of emergent neuroimaging for any child at any age who exhibits a post-ictal deficit (Todd’s paresis) that does not resolve quickly or who has not returned to baseline within several hours. A study done by Sadeq and Karim in Kuwait in 2015 demonstrated no usefulness in evaluating paediatric patients who present with first attack of unprovoked afebrile seizures therefore recommending that neuroimaging should not be performed for these patients.