Article : First Complex Febrile Seizure Portends...

First Complex Febrile Seizure Portends Low Risk for Intracranial Pathology

Fewer than 1% of children with first complex febrile seizure and a normal neurological examination have clinically important intracranial pathology.


Investigators retrospectively assessed risk for clinically important intracranial pathology detected on neuroimaging in previously healthy children ages 6 to 60 months with first complex febrile seizures. The study involved a cohort of 526 patients (median age, 17 months) who presented to a tertiary pediatric emergency department (ED) between 1995 and 2008 within 12 hours of the seizure. Patients with trauma, ventriculoperitoneal shunts, or prior seizure disorders were excluded. Seizures were defined as complex if they lasted >15 minutes, presented as a series, recurred within 24 hours, or if clinical findings suggested focality. Imaging findings were considered clinically important if emergent neurosurgical or medical intervention were required.

Overall, 268 patients underwent head computed tomography (CT), 6 underwent magnetic resonance imaging (MRI), and 8 underwent both. Four patients (1.5%) had clinically important intracranial findings: two intracranial bleeds identified on CT, one right-sided low-density cerebellar lesion identified on CT, and one disseminated encephalomyelitis found only on MRI. Only one patient with clinically important findings (a 4-year-old boy with frontoparietal hematoma that did not require surgery or intracranial pressure monitoring) was otherwise well-appearing and had a normal neurologic exam. Among patients who did not undergo neuroimaging, none returned to the study site within the next 7 days; however, other EDs were not queried. When the analysis included patients who were not imaged but were presumed to be well because they did not return to the ED within 7 days, the risk of clinically important intracranial findings was 0.8%.


Citation(s):


Kimia AA et al. Yield of emergent neuroimaging among children presenting with a first complex febrile seizure. Pediatr Emerg Care 2012 Apr; 28:316.

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