In the setting of a known seizure disorder, abnormal neuroimaging results rarely require acute intervention. Exceptions include finding an acute hemorrhage, suggestive of a possible rupture of an aneurysm or arteriovenous malformation, or finding acute hydrocephalus or imminent brain stem herniation due to mass effect.

In most cases, emergency physicians do not have access to old brain images, and it is rare that intervention needs to be undertaken in the emergency department, unless the patient becomes unstable. If the patient's treating physician cannot be reached, patients with worrisome lesions can be admitted overnight for observation and for formulation of a treatment plan by the next day.

Adapted from: Kolb SJ and Litt B. Management of epilepsy and comorbid disorders in the emergency room and intensive care unit. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;515–535. With permission from Elsevier (

Authored By: 
Steven J. Kolb Md PhD
Brian Litt MD
Reviewed By: 
Steven C. Schachter MD
Saturday, May 1, 2004