DEAR DR. ROACH: I am a 75-year-old woman in reasonably good health. Two months ago, I had a seizure in my doctor’s office during my annual checkup. I woke up in an emergency room in a large metropolitan hospital.

I take ramipril for high blood pressure, which is controlled. I am now taking levetiracetam for seizures. I have never had a seizure before and know of no one in my family who has had one.

Initially I had a CT scan that showed nothing. Two weeks later, I had an electroencephalogram (EEG) that was clear and an MRI. No tumors or aneurysms were found. I am waiting to have a follow-up consultation with the neurology department. All my blood work was fine.

My own general physician said that there might be an age-related disease in the small blood vessels of my brain. What does this mean? She would offer no more information. I suppose she thinks that I should see the assigned neurologist.

I am in shock about this latest development in my health. I had low to normal blood pressure until I turned 70.

In January, I had the worst case of the flu (worse than COVID). I was tested for COVID and was negative. Could this flu have been a factor in my having the seizure?

Is there anything that you can suggest to prevent further seizures? I’ve had no symptoms since and seem to be tolerating the medication well. — D.M.

ANSWER: A new onset of a seizure in a person aged 75 is very concerning, and a thorough evaluation is mandatory. There are many possible causes, and one of them is a tumor, which is one reason they did the MRI. It’s very good news that there was no tumor.

Age-related changes in an MRI are common, and if there has been damage to the brain due to blood vessel changes, this can be a source of seizures. (Between 30 percent and 50 percent of new seizures in older adults are due to blood vessel disease.)

COVID, especially severe COVID, can cause damage to the blood vessels. Most cases of the flu are less inflammatory than COVID, but I suppose it is possible that the flu affected the small blood vessels in your brain. However, if the small blood vessels in your brain really are damaged, I think it more likely that the high blood pressure caused the damage to the blood vessels from when your blood pressure wasn’t as well-controlled than it being due to COVID.

However, many times we cannot find an answer as to why a person has a seizure. As far as treatment, I, too, would await the decision of the epilepsy-trained neurologist, but most recommendations I read would defer long-term treatment in a person with only one seizure when no cause can be identified.

A normal EEG also tends to make me think that the expert would recommend that you hold off on immediate treatment unless you have a second seizure. Still, the neurologist will look at all your data, especially the brain and blood vessel imaging, then give you a recommendation.

CORRECTION: In the July 10 column, we stated that vitamin D “may help people with high-risk prediabetes develop overt diabetes.” It should have read “prevent” rather than “develop.”

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Dr. Keith Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.