From the Guidelines
For a 13-month-old child who experienced a seizure after falling from a window and hitting their head, I would recommend a magnetic resonance imaging (MRI) of the brain without IV contrast as an additional diagnostic study, as it is an equivalent alternative to CT head without IV contrast for the initial imaging of children with post-traumatic seizures, according to the most recent guidelines 1. Given the patient's age and the mechanism of injury, it is crucial to thoroughly evaluate for potential brain injuries that may not be visible on a non-contrast CT head. The initial labs, including CBC, CMP, and CPK, are appropriate for assessing the patient's overall condition, but they may not provide specific information about the brain injury. The non-contrast head CT is a good initial imaging study, but an MRI of the brain without IV contrast may provide more detailed information about potential subtle brain injuries, as suggested by the American College of Radiology Appropriateness Criteria for seizures in children 1. Additional studies, such as an electroencephalogram (EEG), toxicology screen, and electrolyte studies, including calcium, magnesium, and phosphorus levels, may also be considered to evaluate for seizure activity, potential ingestions, and metabolic abnormalities that might lower seizure threshold. However, the most critical next step is to obtain an MRI of the brain without IV contrast to better visualize potential brain injuries and guide further management, as recommended by the most recent and highest quality study 1. It is also important to consider the patient's clinical presentation and the mechanism of injury when determining the need for additional diagnostic studies, such as a skeletal survey or lumbar puncture, as suggested by the guidelines for head trauma in children 1. In this case, the patient's young age and the severity of the injury warrant a thorough evaluation to ensure prompt identification and treatment of any potential complications. The recent study by the American College of Radiology 1 provides the most up-to-date guidance on the appropriate diagnostic studies for children with post-traumatic seizures, and its recommendations should be followed to ensure the best possible outcomes for the patient.
From the Research
Diagnostic Studies for a 13-Month-Old Child After a Seizure
The child in question had a seizure after falling from a window, approximately 3-4 feet, and hitting their head. Initial labs included Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), and Creatine Phosphokinase (CPK), and a Computed Tomography (CT) head noncontrast.
- The CT head noncontrast is a suitable initial diagnostic study, as it has a high sensitivity for detecting subarachnoid hemorrhage (SAH) within 6 hours of symptom onset 2, 3.
- If the CT head noncontrast is negative, a lumbar puncture (LP) may be considered to rule out SAH, especially if the symptom onset is beyond 6 hours 3.
- The role of LP in diagnosing SAH is still significant, particularly in cases with significant anemia or when the CT head noncontrast is negative within the first 6 hours of symptom onset 4.
- Computed Tomography Angiography (CTA) of the brain may also be considered as a diagnostic tool to exclude aneurysmal SAH, with a high sensitivity and specificity for detecting cerebral aneurysms 5.
- For afebrile seizures in children under 1 year, admission to the hospital is recommended, and investigations such as blood glucose measurement may be necessary 6.
Additional Considerations
- The child's age, clinical presentation, and mechanism of injury should guide the selection of diagnostic studies.
- A thorough assessment of the child's neurological status and vital signs is essential in determining the need for further diagnostic studies.
- The results of the initial labs, including CBC, CMP, and CPK, should be evaluated in the context of the child's clinical presentation and the mechanism of injury.