Seizures, Headache & CNS Infection
Separate common neurological symptoms from emergencies requiring immediate treatment and targeted investigation.
Quick revision ↓ Medical Dictionary
01Assess a first seizure
Protect the patient from injury, assess airway and breathing, check glucose and obtain a witness account. Ask about onset, movements, awareness, tongue injury, recovery and possible triggers. Syncope can include brief jerking, so movement alone does not prove epilepsy. Review substances, medicines, metabolic illness and neurological findings. A first event requires an appropriate investigation and specialist plan rather than an automatic lifelong diagnosis.
02Act on prolonged convulsions
A convulsive seizure lasting five minutes or more, or repeated seizures without recovery, needs the emergency status-epilepticus pathway. Call for help, time events and use protocol-led rescue treatment with respiratory monitoring. Check for reversible causes and escalate if seizures persist. Do not put objects in the mouth or restrain the limbs forcibly. Continuing altered consciousness after visible convulsions stop may require further assessment, including for non-convulsive status.
03Identify headache red flags
Sudden maximal-at-onset headache, new focal deficits, fever with neck stiffness, altered consciousness, papilloedema or a substantial change in pattern require urgent evaluation. A thunderclap presentation raises concern for subarachnoid haemorrhage and other vascular causes. Imaging and any subsequent lumbar puncture follow a time-sensitive specialist pathway. Do not assume the absence of a previous headache history is reassuring when onset is abrupt and severe.
04Consider meningitis and encephalitis
Fever, headache, confusion, neck stiffness, seizures or focal findings can suggest CNS infection, but the full classical pattern may be absent. Obtain urgent senior input and appropriate microbiology while starting time-critical treatment without dangerous delay. Lumbar puncture requires an assessment of contraindications and stability; it should not be performed automatically in a patient with signs of raised intracranial pressure or major instability.
05Continuing neurological care
For likely epilepsy, classify the event and select treatment through specialist assessment, considering pregnancy potential, interactions and current medicine restrictions. Discuss safety around water, heights, machinery and driving under local rules. For primary headache, explain diagnosis and avoid medication overuse, while providing clear review triggers. A normal interictal EEG does not exclude epilepsy, and a reassuring single test must not replace the clinical history.
High-Yield Revision
- Time convulsions and treat prolonged seizures as an emergency.
- A normal interictal EEG does not exclude epilepsy.
- Thunderclap headache needs urgent evaluation.
Common Pitfalls
- Do not put objects into a convulsing patient’s mouth.
- Do not delay time-critical CNS-infection treatment while arranging tests.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.