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intoxication - Coggle Diagram

- - - - NMDA antagonist
  - - - NECT對比於CECT的缺點是可能錯過
        vascular anomalies, leptomeningeal processes, and tumours
        
        除了meningeal infections,
        其他的finding幾乎不需要立即的處理
    - - 當前的指南指出，對於首次發作的成人，可以考慮使用緊急CT
        
        立即非對比CT對出現癲癇發作的急診患者可能有用，以指導適當的急性治療，尤其是在神經系統檢查異常，易感病史或局灶性癲癇發作的情況下
      - 但其他指南指出
        
        症狀完全恢復的FS病人
        若無以下症狀可以考慮門診安排神經影像學檢查
        
        an intracranial lesion based on a new focal neurological finding
        history of acute head trauma
        fever
        malignancy
        immunocompromised state
        anticoagulation
        focal seizure onset
        the patient is under 40 years of age
        
        Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures ) (2004), pp. 605-625)
      - EMERGEencyID NET. Selective tomographic imaging of patients with new-onset seizure disorders
        Acad Emerg Med, 9 (January (1)) (2002), pp. 43-47
        
        Recursive partitioning failedto produce a decision rule capable of reliably identi-fying new-onset seizure patients who have importantlesions identiﬁed on CT.
        Future attempts to formu-late such an instrument may need to include addi-tional variables.
        In the interim, physicians should useliberal tomographic imaging in evaluating patientswho present with new-onset seizures
    - - 將神經影像限制在該人群中可能會使頭部CT掃描減少67％，並且可能使頭部MRI掃描減少47％。FS患者應加重臨床懷疑，並考慮對高齡，惡性病史，低血糖或局灶性神經功能缺損進行神經影像學檢查。
    - - 我們的研究加強了美國神經科學院的建議，即患有持續性發作後神經異常狀態和/或發作後局灶性缺陷的兒童應優先考慮出現CT腦。Having excluded children with suspected tuberculous meningitis, the remaining subgroup aged 6 months to 5 years presenting with a non-status first seizure, normal neurological baseline and return to baseline post-seizure, are at very low risk of having a clinically significant CT brain abnormality.
    - - An emergency head CT in adults with first seizure is possibly useful for acute management
        of the patient (Class III).*
    - - CT indication time
        an acute intracranial process is suspected,
        in patients with a history of acute head trauma,
        history of malignancy, immunocompromise,
        fever,
        persistent headache,
        history of anticoagulation
        a new focal neurologic examination,
        age older than 40 years
        focal onset before generalization
  - - - 我們的結果表明，在成人FS患者中，頭痛，局灶性運動體徵，惡性病史或精神狀態改變中的至少一種持續存在，直到ED評估要求進行緊急神經影像檢查為止。即使本研究未進行統計分析，近期的頭部外傷和局灶性癲癇發作特徵也應促使影像學檢查。在沒有這些因素的情況下，考慮到可以確保緊急門診成像並且可以進行可靠的成像前隨訪，推遲成像似乎是安全的
    - - conclusion
        The diagnostic yield of computed tomography of the brain in adults after a first generalised seizure is high.
        Combined with the clinical examination, the CAGE questionnaire can reliably identify patients with uncomplicated seizures related to withdrawal from alcohol, in whom computed tomography may not be absolutely necessary.
    - - Adults who presented with first seizure to the ED in Qatar had a young male predominance, and a high proportion of brain CT scans were reported as abnormal.
        It is recommended that all such patients in this population should undergo prompt CT scanning in the ED , but the utility of routine electrolyte tests requires further investigation.
- - - - 但CT應該可以預測預後因為可以看到腦部受損狀況如腦出血.
        
        切入點不需要在危急時進行
      - 中毒病人的CT表現並無特異性
  - - - 兩篇比較
        
        建議CT
        Intracranial lesions shown by CT scans in 259 cases of first alcohol‐related seizures.
        Neurology 1988; 38: 1561–5
        
        簡單的不需要做
        ED utilization of computed tomography in a poisoned population.
        Am J Emerg Med 2002; 20: 212–7
        
        整段話可以參考
        Computed tomography (CT) is usually not necessary in patients with self‐limited and uncomplicated drug‐induced seizures.
        A prospective observation study showed that patients presenting to the emergency department with altered mental status or headache caused by poisoning or drug overdose had a low likelihood of abnormal findings on head CT scan 31.
        However, another study found that 6.2% of patients presenting to ED with their first alcohol withdrawal seizure had an intracranial lesion on CT scan 32.
        It is reasonable to consider a CT scan in patients with evidence of head trauma, focal or repeated seizures, focal neurological deficits or prolonged alteration of consciousness.
- - - - CT缺點
        
        in nonemergent situations, MRI is more sensitive than CT and is the neuroimaging study of choice
        
        須讓不穩定病人離開急診
        昂貴
        輻射暴露
        seizure診斷性、敏感性不如MRI
      - Computed tomography (CT) is commonly ordered in patients presenting with new-onset seizure to an emergency department.
        It is generally available quickly in that setting and is used to exclude acute neurologic problems that require urgent intervention
        CT is able to identify hemorrhages, gross structural malformations, large tumors, and calcified lesion
        
        重要內容參考及總整理!!!
        最近期的一篇
        Imaging Evaluation of the Adult Presenting With New-Onset Seizure
        AJR Am J Roentgenol. 2019 Jan;212(1):15-25. doi: 10.2214/AJR.18.20202.
        
        Conclusion:
        Unenhanced CT should be the initial imaging examination performed for adults presenting with first unprovoked seizure in the acute setting to exclude conditions requiring urgent or emergent intervention.
        MRI has added benefits and should be considered for adults presenting acutely for whom the initial CT is negative and for those presenting with new-onset seizure in the nonacute setting.