A 14-year old, previously healthy, male abruptly lost consciousness and fell to the floor. His muscles stiffened then began jerking and twitching for about two minutes, a period followed by a sleep-like state. Labs were normal and EEG was abnormal and demonstrated a pattern suggestive of a generalized seizure disorder.
Are imaging procedures necessary for this patient? If so, what would you order?
Immediately, probably not since in a healthy child this age, it is most likely an idiopathic epileptic seizure. However, out of concern for something uncommon and when dealing with a child, he would probably have a MRI performed.
What is your diagnosis?
Generalized tonic-clonic seizure
8 year old boy with 1.5 yr history of seizures. Seizures resolved with medical treatment. No imaging performed. Seizures recurred 3 months ago. Depakote restated. Seizures persisted.
Imaging obtained
A 66 year-old lady presents with a first episode of generalized clonic seizure starting as rhythmical jerking muscle contractions of the arms, neck, and face. Post ictally she complained of numbness involving the left upper and lower extremities.
Are imaging procedures necessary for this patient? If so, what would you order?
Yes, MRI
What is your concern?
Mass lesion/tumor