In recurrent seizures, determination of a sole cause such as noncompliance typically eliminates the need for imaging. Similarly, neuroimaging is not indicated for the evaluation of children with simple febrile seizures. However, the optimal approach for the evaluation of first-time seizures is debated. The American College of Emergency Physicians Special Panel suggests CT scanning for first-time seizures.3

CT is nearly 100 percent sensitive for etiologies of seizures that require emergent intervention such as brain abscesses, hemorrhage, or other space-occupying lesions. However, the neurologist may additionally request multiplanar MRI emergently or electively depending on the clinical situation, although not necessarily while the patient is in the ED.

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