Snapshot A 78-year-old man presents to the emergency department for a headache. He is accompanied by his wife who reports that his headache progressively worsened over the course of weeks. He does not have a history of headaches. Physical examination is normal. A CT head without contrast demonstrates subdural hematomas. Neurosurgery was consulted and determined that the intracranial bleeds were stable but he was admitted to the hospital due to confusion in the setting of a newly found urinary tract infection. After a few days of admission, he had a witnessed generalized-tonic clonic seizure, prompting him to being treated with benzodiazepines. Introduction Definition login to view 1 more bullet Etiology Can begin as a partial seizure that secondarily generalizes Bilateral hemispheric seizures Presentation Symptoms/physical exam login to view 8 more bullets Imaging MRI brain with and without contrast login to view 2 more bullets Studies Patients presenting with a first-time seizure should be evaluated with serum electrolytes, complete blood count, glucose, and a urine toxicology screen prior to further testing Electroencephalogram login to view 2 more bullets Lactate login to view 1 more bullet Differential Psychogenic nonepileptic seizures (PNES) login to view 4 more bullets Migraine with aura login to view 2 more bullets Treatment Medical login to view 7 more bullets Complications Behavioral and cognitive alterations Aspiration Head strike