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First unprovoked seizure in an adult — RACP Adult Medicine MCQ

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ModerateNeurologyFirst unprovoked seizure in an adultRACP Adult Medicine

A 44-year-old man has a witnessed generalised tonic-clonic seizure at work. He has recovered fully. Sodium, calcium, glucose and ECG are normal, and there is no alcohol withdrawal history. Neurological examination is normal. What is the most appropriate investigation?

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Correct answer: C — MRI brain and EEG arranged urgently after initial assessment

A first unprovoked adult seizure requires evaluation for structural and epileptiform causes, commonly with MRI and EEG. Normal examination does not exclude a lesion or epilepsy syndrome. Prolactin is not a longitudinal diagnostic strategy, carotid ultrasound is unrelated, and lumbar puncture is reserved for suspected infection or inflammation.

Reference: Epilepsy Society of Australia guidance; AMH