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Objective: To determine the prevalence of intracranial lesions in first-ever generalized tonic-clonic seizures in adults presenting in the Emergency Department (ED). Main outcome measure was the prevalence of intracranial lesions in cranial computerized tomography (CT). Method: 76 consecutive patients aged 18 years and above, with first-ever, non-traumatic, generalised tonic-clonic seizures that were evaluated in the ED with cranial CT, had their CT films reviewed by a specialist Radiologist. Demographic characteristics of participants were computed. The participants were divided into two groups-the group with intracranial lesions and the other without and their characteristics were compared. Main outcome measure was the presence of intracranial lesions in cranial computerized tomography. Results: Intracranial lesions were found in 57.9% of cases; cerebral atrophy and acute vascular disorders (strokes) were the leading lesions. Mean age of cases with intracranial lesions was higher compared with those with normal CT findings (55.31±17.33 years versus 38.90 ±14.69 years; p