Seizures Flashcards
Unresponsive kid DDx?
Toxic ingestion Seizures Syncope (breath holding vs cardiac) Closed head injury Infection
Seizure vs seizure-like activity
true seizures –> excessive neuronal brain activity
- LOC, deviation of eyes, incontinence, rhythmic motor movements, post-tictal state
General Tonic-clonic
most common in kids
- abruptly with stiffening of body followed by upward deviation of eyes
- clonic jerks of all extremities
- flaccid and urinary incontinence
Simple partial seizure
motor signs of single extremity
- may spread to more of the body
Complex partial seizure
alteration of consciousness
- glassy eyes, smacking lips, drooling, N/V
- repeatedly inappropriate verbal and motor signs
- 30 sec - 2 min with sleep following
- 2nd generalized seizures can follow
Childhood absence epilepsy
petit-mal seizures –> starts around age 3
- usually regain consciousness quickly
- no loss of tone or incontinence
Atonic seizure
Loss of motor tone
Determining Etiology of Seizure?
Description of event? History of fever/illness? Movement prior/post? Toxic ingestion? Family History? Trauma?
Developmental and seizures
Kids who are developmentally delayed that have seizures may have 1 thing related to both conditions
- pre-existing developmental abnormalities increase the risk for epilepsy
Heredity and febrile seizures
febrile seizures are hereditary -> don’t know inheritance
DDx of febrile seizure in kids
- CNS infection –> encephalitis/meningitis
- Febrile seizure –> can occur with little to no infection (fam hx)
- Head injury –> 1-2 hrs post-incident
- Ingestion/poison –> generally not associated with fever
- Idiopathic
- Hypoglycemia
- Brain tumor
Fever without a source
term used in the acute setting (within 48 hrs)
Fever of unknown origin
term used in the chronic setting (days)
DDx for fever in kids
Meningitis SBI Occult Bacteremia UTI Kawasaki Disease Viral syndrome Septic arthritis Sepsis Otitis Media
Decreasing risk of SBI
Even though the risk is low in an immunized kid, the possibility of missing it and progressing to sepsis or meningitis is enough for pediatricians to do a blood culture
When to obtain an LP?
NEED CLINICAL JUDGEMENT!
- persistent irritability
- serious illness
- signs and symptoms
Work-up for first NON-febrile seizure
EEG - will show brain activity +/- epilepsy
MRI - structural info
CT - structural info
Lumbar Puncture
CORRECT POSITION AND ADEQUATE RESTRAINT
- lateral recumbant position and spine flexed
- L3-L4 level
- POP felt when entering dura
- CSF drips into collection tube
- may need “opening” pressure
Bacterial Meningitis
one of the most serious infections
2 mon - 12 years = S. pneumo, N. meningitidis
Presentation of bacterial meningitis
Fever Lethargy Anorexia Tachycardia Myalgias
Treatment of bacterial meningitis
high dose IV Abx –> 3rd gen cephalosporin or vancomycin
- 7-14 day duration
Complications of bacterial meningitis
Stroke
Subdural effusions
SIADH
CSF results of bacterial meningitis
Glucose - decreased
CSF gluc/blood gluc - decreased
Protein - elevated
WBC - elevated
Traumatic spinal tap
hitting a vessel when doing tap –> it results in bloody fluid
- ways to correct the labs
CSF in viral meningitis
Glucose - normal
CSF gluc/blood gluc - normal
Protein - normal
WBC - elevated
Febrile Seizures
Simple
- common, 15 minutes, >1x 24 hrs, focal
Risk of recurrence of febrile seizues
if occur before 12 months = 50% recurrence
if occur after 12 months = 30% recurrence
Risk of epilepsy
febrile seizure = 0.5-1% chance of epilepsy
- risk increases in recurrent febrile seizures or fam history
Guidance for febrile seizures
Fever - tylenol and ibu ok but don’t prevent seizures
Seizure again - place child on side away from hurting themselves
Meds - weigh risks/benefits
Blanching definition
rash turns white when pressed on and then returns to red color
Roseloa infantum
caused by HHV-6. High fever followed by rash on trunks
- can be the cause of febrile seizure
