Practice Parameter: Neuroimaging in the Emergency Patient
Presenting With Seizure

Developed by the American College of Emergency Physicians (ACEP),
the American Academy of Neurology (AAN), the American Association
of Neurological Surgeons (AANS), and the American Society of
Neuroradiology (ASN).
September 14, 1995

A. For patients with first-time seizure:
1. Emergent NI (scan immediately) should be performed when a provider suspects a
serious structural lesion. Clinical studies have shown a higher frequency of lifethreatening
lesions in patients with new focal deficits, persistent altered mental status
(with or without intoxication), fever, recent trauma, persistent headache, history of
cancer, history of anticoagulation, or suspicion of AIDS (Guideline).
2. Urgent NI (scan appointment is included in the disposition or is performed prior to
disposition when follow-up of the patient's neurologic problem cannot be assured)
should be considered for patients who have completely recovered from their seizure and
for whom no clear-cut cause has been identified (eg, hypoglycemia, hyponatremia,
tricyclic overdose) to help identify a possible structural cause. Because adequate followup
is needed to ensure a patient's neurologic health, urgent NI may be obtained prior to
disposition when timely follow-up cannot be assured (Option).
3. Additionally, for patients with first-time seizure, emergent NI should be considered if
any of the following is present (Option):
a. Age over 40 years
b. Partial-onset seizure
B. For patients known to have epilepsy with recurrent seizure(s):
1. Emergent NI (scan immediately) should be performed when a provider suspects a
serious structural lesion. Clinical studies have shown a higher frequency of lifethreatening
lesions in patients with new focal deficits, persistent altered mental status
(with or without intoxication), fever, recent trauma, persistent headache, history of
cancer, history of anticoagulation, or suspicion of AIDS (Guideline).
2. Urgent NI (scan appointment is included in the disposition or performed prior to
disposition when follow-up of the patient's neurologic problem cannot be assured)
should be performed for patients who have completely recovered from their seizure and
for whom no clear-cut cause has been identified (eg, hypoglycemia, hyponatremia,
tricyclic overdose) to help identify a possible structural cause. Because adequate followup
is needed to ensure a patient's neurologic health, urgent NI may be obtained prior to
disposition when timely follow-up cannot be assured (Option).
3. Additionally, for patients with recurrent seizure (prior history of seizures) emergent NI
should be considered if any of the following is present (Option):
a. New seizure pattern or new seizure type
b. Prolonged postictal confusion or worsening mental status
C. Patients with typical febrile seizures or patients with typical recurrent seizures related to
previously treated epilepsy are unlikely to have life-threatening structural lesions. These
patients do not require emergent or urgent NI (Guideline).