Imaging recommendation · Neuro · Head & Neck

Status epilepticus or new refractory seizure

Q: What's the alternative imaging for status epilepticus or new refractory seizure when etiology suspected to be infectious or inflammatory?

MRI — MRI Brain with and without contrast + LP (iv contrast).

Q: What's the alternative imaging for status epilepticus or new refractory seizure when refractory non-convulsive status?

Continuous EEG (imaging adjunctive) (no contrast).

Recommended: CT Head non-contrast + MRI Brain when stable is the preferred imaging study for status epilepticus or new refractory seizure. CT first for emergent causes; MRI for structural / inflammatory etiology after stabilization.

Recommended study

CT Head non-contrast + MRI Brain when stable

CT No contrast Preferred Neuro · Head & Neck EmergencyAcute inpatient Reviewed 2026-05

CT first for emergent causes; MRI for structural / inflammatory etiology after stabilization.

If the default doesn't apply

Etiology suspected to be infectious or inflammatory

MRI MRI Brain with and without contrast + LP IV contrast

Refractory non-convulsive status

Continuous EEG (imaging adjunctive) No contrast

Watch-outs

Treat the seizure first

Benzodiazepine → second-line AED (levetiracetam / fosphenytoin / valproate) → anesthesia if refractory; imaging follows stabilization.

Refractory status with no clear etiology

Consider autoimmune encephalitis, acute toxic-metabolic, mitochondrial — imaging may guide further work-up.

Pearls

Post-ictal MRI may show DWI restriction and cortical T2 hyperintensity that resolves over weeks.
Common precipitants: AED non-compliance, electrolyte derangement, infection, stroke, withdrawal.
New-onset refractory status epilepticus (NORSE) — broad differential including autoimmune, paraneoplastic.