seizure

DC Inst – Seizure

DC

You have been evaluated in the Emergency Department today for a seizure. Your evaluation, including labs and a CT of your brain, were unremarkable. Do not drive until you are cleared by a physician.

Please follow up with your primary care physician within two days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.

Return to the Emergency Department if you experience recurrent seizures, difficulty walking or moving your arms or legs, slurred speech, difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.

Thank you for choosing us for your care.

SEIZURE – General

MDM

This patient presents with symptoms consistent with acute seizure, most likely due to ***. I considered, but think less likely, secondary etiologies of epileptic seizures to include drug / toxin etiologies (ETOH, stimulants, medication side effects), metabolic disturbances (glucose, Na), acute CNS infections (meningitis, encephalitis, abscess), ICH / tumor / CVA. Presentation not consistent with non-epileptic type seizure to include syncope, neurologic etiologies (vertebrobasilar insufficiency, movement disorder, migraine), impact seizure related to head trauma.

Plan: BZDs, labs***, CT brain***, seizure precautions, Neurology consult***, reassess

Pearls

Consider nonconvulsive status: persistent change in behavior that lasts 30 minutes after a seizure. Look for positive symptoms (twitching, eye deviation, jerking) and negative (aphasia, catatonia, mutism). Many patients will just not respond. Think about this in head trauma patients with a decreased GCS and a negative initial CT. Also consider this in a “septic” altered patient with a borderline positive UA that isn’t that convincing.