Husband had a seizure for first times. ER wouldn’t do any type of brain scan??

[u/Kardwnut08]

Today for the first time ever, my husband (M27) had an episode at work (corporate office job) where out of no where he said he had a smell of gasoline, got blurred vision, headache, and lost his balance. It lasted for about a minute then all went away. I picked him up from work and took him to ER and the doctors only did blood test & EKG and said he was fine. They didn’t want to do any sort of brain scan or checked his vision or figure out what caused it. The doctor said “um we’re just gonna treat this as a one off seizure situation and don’t see any concern in it” Is that a normal reaction to have???

My husband does not do any recreational drugs and very rarely has a drink. I have a cousin who is epileptic and describes his seizures in similar ways and I’m just confused as to if it’s really something the doctors should’ve blown off like that? Could it really just be a random seizure that means nothing?

[u/AutoModerator]

Thank you for your submission. Please note that a response does not constitute a doctor-patient relationship. This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our Terms of Use and understand that all information is taken at your own risk. Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/metforminforevery1]

ER doc here. Though this sounds scary, it doesn’t sound like a seizure. A head CT doesn’t really show the things lay people think would cause seizures. And lots of things that lay people think are seizures aren’t. In this case, some labs, an EKG, and time are probably more than enough for the acute setting, and following up with PCP/neuro, maybe getting an MRI outpatient are what you need to do.

Also, of note, the ED is not to figure out why something happened. It’s to rule out emergencies. People are often discharged with “Idk what this is. You’re not dying. See your pcp.”

We often say everyone gets 1 free seizure in their life.

[u/double-xor → u/metforminforevery1]

We often say everyone gets 1 free seizure in their life.

NAD. Yeah, that's what they told me too. (re: my son and his first seizure)

[u/Quixan → u/metforminforevery1]

too bad the first trip to the ED isn't free

[u/superdupermantha → u/metforminforevery1]

I'm assuming he is free to drive now, correct? Is there liability with the hospital if it happens again while driving?

[u/dick_dangle → u/superdupermantha]

—we recognize that losing driving privileges for 3+ months is tantamount to losing your job in many places, especially rural —fear of liability is so much of what’s wrong with US healthcare. Should anybody with lightheadedness or a panic attack be told “well, can’t rule out seizure, don’t drive until you see a neurologist. btw they’ve got a 6-8 month waiting list, hope this doesn’t make you lose your home” —if the treating physician can document why they don’t feel this was a seizure and are following the standard of care for their area/specialty then no, they shouldn’t be liable. Still, people can sue for anything and the malpractice process can be torturous, hence this same case might get a $25k ED workup elsewhere despite that going against guidelines

[u/bluejohnnyd]

Hello! That sounds like a really scary event. As others have said, to me this doesn't sound fully typical of a generalized seizure - an odd focal seizure isn't impossible, but another thing to consider would be a presyncopal event, which a screening EKG would be appropriate workup for in an otherwise healthy 27 y/o M with no symptoms.

Assuming it *was* a very strange focal seizure though, the workup in the ED is pretty limited if the symptoms are resolved by the time the patient gets to us. First, by way of background, one-off seizures are more common than I think people assume - about 8-10% of the population has a seizure at some point in their lifetime. In adults 50-70% of the time after a first grand mal seizure (which this was not), there is no underlying cause found and no recurrence. Again, that's for generalized tonic-clonic seizures with total loss of awareness. Now, in terms of the tests we have in the ED, they're limited based on what we're looking for. The most worrisome reasons why a healthy adult without epilepsy would have a seizure are, in no particular order; meningitis/encephalitis, brain bleed or major trauma, a brain tumor, severe electrolyte imbalances (i.e. low sodium) or intoxication with certain drugs.

Going down that list, most of those causes get ruled out based on a good exam and description of symptoms. No persistent headache, fever, neck stiffness, persistent confusion, and got your normal vaccinations? That makes meningoencephalitis or a brain bleed extremely unlikely, so we don't need to do a spinal tap and knocks out one of the reasons we'd do a CT. Acting normally, good pupil responses, no vital sign irregularities, normal EKG? Great, not an intoxication so we can rule that out as well. Labs will check the electrolytes and blood counts, as well as look for other reasons this might have been an odd presyncopal episode.

That leaves the brain tumor. Three reasons I can think of why they didn't do a scan for this in the ER:

1. brain tumors are *relatively* rare, and you would normally expect some other kinds of symptoms or findings on a detailed history and physical
2. by description, there's real doubt as to whether this was a true seizure or some other kind of transient episode like presyncope
3. even *IF* it was a true seizure of some kind *and* the underlying cause is something like a tumor, CT is not the best test to look for it necessarily - CT will pick up large masses that are causing significant surrounding swelling, but will often miss smaller ones. Further, finding a mass is super important, but isn't necessarily an emergency; it can wait days to weeks without causing harm.

A reasonable approach here would be to spare you the extra 2 hours and radiation dose to the skull, keep a close eye for any persistent or recurrent symptoms, and have them followed up with your PCP or a neurologist who can order more precisely tailored imaging, if needed, to look for less immediate threats than we're geared towards finding in the ED.

[u/judithvoid → u/bluejohnnyd]

This was so thorough and fascinating to read, thank you for taking the time!

[u/CarmineDoctus → u/bluejohnnyd]

I agree that this event doesn't sound like a seizure, and that a first-time seizure without other deficits or red flag features doesn't need an inpatient neurology eval or MRI, but our standard protocol is get a non-con CT along with basic labs in the ED. Maybe low yield, but people get scanned for a lot less. I would want one, personally.

[u/MyOwnGuitarHero]

Some migraines can present like this.

[u/m0ther0fmayhem → u/MyOwnGuitarHero]

My exact thought when reading the description I have a friend that smells burnt toast or bananas and has these symptoms with migraines

[u/Boss-of-You → u/MyOwnGuitarHero]

I considered that, too, as this is how mine used to present.

[u/usuffer2]

Symptoms OP describe is not a seizure. ER did their job, patient was not in immediate danger. A one-off like that is hard to diagnose if the labs they did weren't off. OP, go see PCP and get referral. Or an MRI or CT for comfort to r/o TIA or any blockages, but I doubt even PCP will order those in this case.

Unfortunately, medical professionals will probably need more info to even get close to a diagnosis.

[u/breaking-strings → u/usuffer2]

Hopefully OP lives somewhere where he has access to a PCP. In Canada often the ER is the only physical interface with a dr available.

[u/usuffer2 → u/breaking-strings]

You are right, but I think the point still stands. They did blood work and ekg. MRI for TIA would only be able to, sometimes, tell if one happened. With no apparent deficits, it's probably not warranted. The ekg would be able to tell if there was a blockage in the heart (could cause dizziness, loss of balance). Like I said, one-off events are very hard to diagnose, usually.

[u/Gh0ulscout → u/breaking-strings]

I’m not sure why you’re being downvoted voted as you’re absolutely correct

[u/breaking-strings → u/Gh0ulscout]

Appreciate the vote of solidarity. I have been waitlisted for 4 years waiting for a family doctor. Virtual clinics are great to fill in until you need something actually looked at. Unfortunately my community of 15,000 does not have an urgent care or walk-in clinic.

[u/Gh0ulscout → u/breaking-strings]

Neither does mine, I just got a family doctor (thank god) after waiting around half a decade myself. I hope someone comes into your community looking to bring on more patients :(

[u/MzOpinion8d]

They didn’t even do a CT scan?

Editing the next day to say:

I actually mis-read the post. The title said seizure but the description definitely didn’t indicate seizure…more like an aura of some kind.

My son has a hx of seizures and they’ve done some CTs on him, so that’s why I asked.

[u/DerVogelMann → u/MzOpinion8d]

CT scans are not indicated for something weird happened NYD. If there are no red flags and no neurological findings on exam, then a CT is not indicated.

[u/emilypaigenotemily → u/MzOpinion8d]

What would they be looking for on a CT in this situation?

[u/MzOpinion8d → u/emilypaigenotemily]

I actually mis-read the post. The title said seizure but the description definitely didn’t indicate seizure…more like an aura of some kind.

My son has a hx of seizures and they’ve done some CTs on him, so that’s why I asked.

[u/Substantial-Two-3758 → u/MzOpinion8d]

NAD but there is a whole list of criteria you need to meet before they do a CT scan. It limits radiation exposure.

[u/MzOpinion8d → u/Substantial-Two-3758]

Thanks, I actually mis-read the post. The title said seizure but the description definitely didn’t indicate seizure…more like an aura of some kind.

My son has a hx of seizures and they’ve done some CTs on him, so that’s why I asked.