HMPAO SPECT or SPECT/CT Brain Ictal and Interictal There is no relevant literature regarding the use of single-photon emission computed tomography (SPECT) or SPECT/CT as an initial imaging study in the evaluation of new-onset seizure unrelated to trauma. Variant 2: New-onset seizure. History of trauma. Initial imaging. CT Head Noncontrast CT has a central role in the emergent situation of immediate post-traumatic seizures as it can accurately and rapidly identify pathology related to trauma, such as acute intracranial hemorrhages, and other pathology that may be the cause of the apparent traumatic condition, including stroke, cerebral edema, vascular malformation, hydrocephalus, skull fractures, foreign bodies, and tumors [14-16,19]. CT can quickly identify mass effect, such as tonsillar herniation or midline shift, that requires urgent intervention. CT can be performed quickly and without the need for screening for ferromagnetic materials. However, note that the overall success of CT in detecting focal lesions in epilepsy is low at approximately 30% [17]. There is no role for contrast-enhanced CT in the setting of trauma. FDG-PET/CT Brain There is no relevant literature regarding the use of FDG-PET/CT as an initial imaging study in the evaluation of new-onset seizure with history of trauma. Recent literature has described increases in amyloid levels in TBI using PET amyloid; however, the use of this modality remains investigational [20]. MEG There is no relevant literature regarding the use of MEG as an initial imaging study in the evaluation of new-onset seizure with history of trauma. MRI Functional (fMRI) Head There is no relevant literature regarding the use of fMRI as an initial imaging study in the evaluation of new-onset seizure with history of trauma. There is evidence that TBI can be associated with both increases and decreases in cerebral blood flow during the acute stages of injury; however, the use of this modality remains investigational [20].
Seizures and Epilepsy. HMPAO SPECT or SPECT/CT Brain Ictal and Interictal There is no relevant literature regarding the use of single-photon emission computed tomography (SPECT) or SPECT/CT as an initial imaging study in the evaluation of new-onset seizure unrelated to trauma. Variant 2: New-onset seizure. History of trauma. Initial imaging. CT Head Noncontrast CT has a central role in the emergent situation of immediate post-traumatic seizures as it can accurately and rapidly identify pathology related to trauma, such as acute intracranial hemorrhages, and other pathology that may be the cause of the apparent traumatic condition, including stroke, cerebral edema, vascular malformation, hydrocephalus, skull fractures, foreign bodies, and tumors [14-16,19]. CT can quickly identify mass effect, such as tonsillar herniation or midline shift, that requires urgent intervention. CT can be performed quickly and without the need for screening for ferromagnetic materials. However, note that the overall success of CT in detecting focal lesions in epilepsy is low at approximately 30% [17]. There is no role for contrast-enhanced CT in the setting of trauma. FDG-PET/CT Brain There is no relevant literature regarding the use of FDG-PET/CT as an initial imaging study in the evaluation of new-onset seizure with history of trauma. Recent literature has described increases in amyloid levels in TBI using PET amyloid; however, the use of this modality remains investigational [20]. MEG There is no relevant literature regarding the use of MEG as an initial imaging study in the evaluation of new-onset seizure with history of trauma. MRI Functional (fMRI) Head There is no relevant literature regarding the use of fMRI as an initial imaging study in the evaluation of new-onset seizure with history of trauma. There is evidence that TBI can be associated with both increases and decreases in cerebral blood flow during the acute stages of injury; however, the use of this modality remains investigational [20].