Neuroimaging Patterns in Adult Patients with New-Onset Seizures: A Five-Year Emergency Department Study in Riyadh

Background Neuroimaging plays a critical role in the evaluation of patients presenting with new-onset seizures. This study aimed to explore the epidemiological characteristics of patients presenting to the emergency department (ED) with first-time seizures. Methods This was a single-center, retrospective cohort study, utilizing data extracted from the electronic hospital system for adult patients who presented with new-onset seizures over a 5-year period. Results The study included 323 patients (61% male), with a mean age of 43 years. Generalized tonic-clonic seizures were the most common seizure type (84%). Brain Computed tomography (CT) scans were normal in 65% of cases, while 35% showed abnormalities, primarily post-stroke sequelae (10.5%), acute stroke (6.8%), and neoplasms (6.5%). Patients with abnormal CT findings were older and had more comorbidities. Logistic regression analysis identified age and focal seizures as significant predictors of abnormal CT findings, while a history of stroke was inversely associated. Conclusion CT imaging identified abnormalities in 35% of patients with new-onset seizures, with age and focal seizures serving as key predictors. These findings support a risk-based approach to neuroimaging in the ED setting.