Diagnostic Dilemma

Atypical Febrile Seizure

A 7-month-old boy born of non-consanguineous marriage presented with 3 episodes of convulsions in one hour, fever and cough, cold for 1 day. The 1st convulsion was generalized tonic-clonic associated with uprolling of eyes and lasted for 3 minutes without postictal drowsiness, 2nd convulsion occurred after 10 minutes and was left-sided focal and responded to Inj Phenobarbital and midazolam. The third convulsion was also a left focal convulsion. Milestones, birth history is non-contributory. On examination, he was conscious, had normal vital parameters. Anterior fontanelle was open, level. Blood pressure was normal. There were no rickets, meningeal signs, or any focal neurological deficit. The treating physician diagnosed him as atypical febrile convulsion.

Is the diagnosis of atypical febrile convulsion correct?
Expert Opinion :
This child has presented with 3 episodes of seizures with fever in a span of one hour. Each time the child had no postictal drowsiness. Also there are no meningeal signs, signs of rickets, hypertension or focal neurological deficit. Thus, the child appears to be normal in between seizures. However, this child has focal seizures and before labeling a child as febrile convulsion it is always necessary to rule out other causes such as meningitis even if there are no meningeal signs. Since the sensorium is normal in between the seizures, one should rule out viral meningitis. With bacterial and tuberculous meningitis, the child would be sicker. CSF in this child confirmed aseptic meningitis (72 cells, 100% lymphocytes with normal sugar and proteins).
Answer Discussion :
adalarasan natesan
no co. plex febrile
1 year ago
Dr Satish Kumar
eeg, CBC, CRP,urine routine,culture.
febrile seizures?

1 year ago

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