A Case of Atypical Febrile Seizures

8/8/2019 A Case of Atypical Febrile Seizures

1/17


2/17

6 yr old s/o serving soldier presented on 026 yr old s/o serving soldier presented on 02Aug,09 at 2000 hrsAug,09 at 2000 hrs

Fever Fever--12hrs12hrs

Seizure involving left upper and left lower Seizure involving left upper and left lower limblimb --1930 hrs1930 hrs


3/17

H/o high grade fever of 12 hrs durationH/o high grade fever of 12 hrs duration No chills and rigors No chills and rigors

H/o Tonic/Clonic febrile seizure involvingH/o Tonic/Clonic febrile seizure involvingLU and LL.LU and LL.

Seizure lasted for around 1Seizure lasted for around 1- -2 mins2 minsDuring PostDuring Post ictal phase child wasictal phase child wasconscious,oriented but drowsy.conscious,oriented but drowsy.


4/17

No H/o projectile vomiting, neck stiffness No H/o projectile vomiting, neck stiffness,headache, irritability.,headache, irritability.

No H/o chronic cough, prolonged fever, No H/o chronic cough, prolonged fever,significant weight loss with decreasedsignificant weight loss with decreasedappetite.appetite.


5/17

PAST HISTORYPAST HISTORY

H/o febrile convulsion(5H/o febrile convulsion(5- -6 times )6 times )

First episodeFirst episode Child was 7 months oldChild was 7 months old

Last episodeLast episode- -2 years back 2 years back

MRI Done at the age of 7 monthsMRI Done at the age of 7 months- -Normal Normal

Lumbar punctureLumbar puncture- -WNLWNL


6/17

BIRTH HISTORYBIRTH HISTORY

Full Term Normal Vaginal delivery.Full Term Normal Vaginal delivery. No h/o instrumentation No h/o instrumentation- -forceps ,vaccum.forceps ,vaccum.

No h/o Meconium stained liquor. No h/o Meconium stained liquor.Baby cried immediately after birth.Baby cried immediately after birth.


7/17

D EVELOPMENTAL HISTORYD EVELOPMENTAL HISTORY

Child achieved all the milestones according toChild achieved all the milestones according tohis age.his age.


8/17

FAMILY HISTORYFAMILY HISTORY

No relevant family history No relevant family history No h/o febrile seizures in siblings No h/o febrile seizures in siblings


9/17

TREATMENT HISTORYTREATMENT HISTORY

The child was not on any medication for The child was not on any medication for febrile seizures.febrile seizures.


10/17

G ENERAL EXAMINATIONG ENERAL EXAMINATION

Child was conscious,oriented.Child was conscious,oriented.PulsePulse--90/min, regular 90/min, regular

RR RR--24/min24/minTempTemp--101F101F

No pallor,cyanosis,icterus No pallor,cyanosis,icterus

Spo2Spo2--96% on room air 96% on room air


11/17

SYSTEMIC EXAMINATIONSYSTEMIC EXAMINATION

Central Nervous SystemCentral Nervous System- -Higher Mental FunctionsHigher Mental Functions- -Child was drowsyChild was drowsy

in post ictal phase .in post ictal phase . No focal Neurological deficit No focal Neurological deficit No neck stiffness No neck stiffness

Kernigs signKernigs sign--Negative NegativeBrudzinski signBrudzinski sign- -Negative Negative


12/17

CONT D.CONT D.

CVSCVS--S1 S2 HeardS1 S2 Heard No Murmur No Murmur

RESPIRATORY SYSTEMRESPIRATORY SYSTEM- -Bilateral normalBilateral normalvesicular breath sounds heard.vesicular breath sounds heard.

ABDOMENABDOMEN- - Soft, NonSoft, Non--tender tender No organomegaly No organomegaly


13/17

PROVISIONAL D IA G NOSISPROVISIONAL D IA G NOSIS

FEBRILE CONVULSIONS(ATYPICAL)FEBRILE CONVULSIONS(ATYPICAL)


14/17

INVESTI G ATIONSINVESTI G ATIONS

HbHb--11.1gm %11.1gm %

TLCTLC--10,900/cumm10,900/cumm

DLCDLC--P88 L09 M01 E02P88 L09 M01 E02Liver Function TestLiver Function Test- -Serum BilirubinSerum Bilirubin- -.6 mg/dl.6 mg/dlSGOTSGOT--3939SGPTSGPT--3535Alkaline phosphataseAlkaline phosphatase- -10 6 U/L106 U/L


15/17

MPMP--Not Seen Not Seen

Mal Check Mal Check--Negative Negative

CT Scan BrainCT Scan Brain- -NAD NAD

EEGEEG--Abnormal findings suggestive of Abnormal findings suggestive of EpilepsyEpilepsy


16/17

TREATMENTTREATMENT

Inj DiazepamInj Diazepam- -4mg iv sos4mg iv sos

Inj Ampicillin 500mg iv 8hrlyInj Ampicillin 500mg iv 8hrly

Syp Na ValproateSyp Na Valproate- -200mg bd200mg bd

Syp ParacetamolSyp Paracetamol- -10ml tds10ml tds


17/17

PRESENT STATUSPRESENT STATUS

AsymptomaticAsymptomatic

AfebrileAfebrile

Seizure freeSeizure free

Discharged on 6 Aug,o9Discharged on 6 Aug,o9--Syp Na valproateSyp Na valproate- -200mg200mg bd. bd.

Advise Regular Follow up.Advise Regular Follow up.

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A Case of Atypical Febrile Seizures