Evaluation of the ED Patient with a First Time Seizure

On physical exam her vital signs are blood pressure 120/80, pulse 68, respiratory rate 14, temperature 98, pulse oximetry 98% saturated. She is alert, oriented to person, place, and time; she can recite the months of the year forward and backwards, has 3 object recall after 5 minutes. Cranial nerves II, III, IV, and VI are intact including a normal appearing fundus with venous pulsations. There is no facial asymmetry, speech is fluent, swallowing is normal. She has no upper or lower extremity weakness and her gait is normal. Her deep tendon reflexes are +4 symmetrically in both the upper and lower extremities; her extensor planter reflexes (Babinski’s) are upgoing bilaterally.