Which of the following are differential diagnoses to consider for a new-onset seizure?

• A. Migraine with aura
• B. Mental health crisis only
• C. Syncope with convulsive features, PNES, metabolic disturbances, intoxication, brain tumor, infection/ meningitis
• D. Asthma attack

Answer: (C)

When a patient has a new-onset seizure, the important idea is to think beyond epilepsy and consider a wide range of other causes that can provoke or mimic seizures. The best answer includes several broad categories that cover most realistic scenarios: syncope with convulsive features, psychogenic non-epileptic seizures (PNES), metabolic disturbances, intoxication, brain tumors, and infections such as meningitis. Each of these can alter brain function in a way that looks like a seizure or can trigger one, so recognizing them helps you guide the workup—history, physical exam, labs, imaging, and possibly lumbar puncture—to distinguish epilepsy from other etiologies and treat appropriately.

The other options don’t capture this breadth. Migraine with aura can involve neurologic symptoms but isn’t a comprehensive differential for a new seizure onset. A mental health crisis alone is too narrow and ignores medical mimics and underlying physiological causes. An asthma attack is unrelated to seizure etiology.