Diagnostic Dilemma


A 10 months old boy presented with fever for 7 days and excessive crying for 6 days. Fever was accompanied by vomiting initially which subsided within 2 days. Mother had open tuberculosis and was on antituberculous therapy {ATT} for past 1 week. The child was a full term normal delivery on top feeds with normal milestones and immunized for age including BCG. The child was investigated for same and CSF was normal. MRI brain showed frontotemporal enlargement of CSF spaces. The child was put on Phenobarbitone and Phenytoin and Ceftriaxone for these complaints. On examination, child was irritable without any focal neurological deficit. Systemic examination was normal. CBC, liver enzymes and electrolytes were normal.

What could be the cause of irritability_?
Expert Opinion :
Lot of viewers have suggested TBM. But, the child`s MRI is inconclusive, there are no basal exudates or infarcts or tuberculoma. The CSF picture is also normal. Thus would we consider any sort of meningitis at all_?

What about a metabolic disorder that may have got decompsated with this episode especially since child is not having seizures but still is on Phenobarbitone and phenytoin.
Answer Discussion :
sarah Ashour
increased in intracranial preesure
12 years ago
Khalid Mannan
2 AED`s!!
12 years ago

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