Child with Fever and Seizure

at what is age should be performed and considered to do Lumbar Puncture?

- Should be: all infants <6 month of age who present with fever and seizure unless contraindicated - Considered: <12 months old especially if child has not received Hib and pneumococcal immunization or for whom immunization status is unknown

what is the treatment of bacterial meningitis?

C. penicillin + Cefotaxime - Ceftriaxone gives more rapid CSF sterilization as compared to Cefotaxime or Cefuroxime

clinical features of encephalitis

Fever Headache Sore throat Abdominal complaints - cognitive dysfuntion ( acute memory loss) - behavioral changes ( hallucinations, psychosis) - cranial nerve abnormalities ( oculomotor and facial nerve)

What is the clinical approach in febrile seizure?

Hx: - Hx of febrile seizure - age of patient - Hx of developmental delay - seizure ( duration, characteristics)

Etiology of bacterial meningitis?

Neonatal to 3 months: - group b streptoccocci - E.coli 1 month to 6 years: - Neisseria meningitides - Haemophilus influenza >6 years: - Neisseria meningitidis - Strep pneumoniae

clinical features of bacterial meningitis

Neonates: Fever Poor feeding Seizures Bulging fontanelle Infants: Fever Tachycardia Bulging fontanelle Older child: Headaches Neck stiffness Photophobia Fever

differentiate between simple and complex febrile seizure

Simple febrile seizure: Duration : <15 minutes Generalised tonic-clonic seizure Does not recur during the febrile episode (within 24 hour) Complex febrile seizure: - greater than 15 min - >1 seizure during the febrile episode - elicit neurological deficit

what is bacterial meningitis?

inflammation of the meninges covering the brain. (Confirmed: white blood cells in CSF)

What is a febrile seizure?

- a seizure that occur in association with fever (>38°C) with no evidence of intracranial pathology or metabolic derangement in - children between 3 months and 6 years of age. - temperature rises rapidly.

DD of encephalitis

- acute hypoglycemia - leptospirosis - meningitis - status epilepticus

medications of encephalitis

- acyclovir & foscarnet ( to shorten clinical course , prevent complication) - dexamethasone ( treatment of postinfectious encephalitis and acute disseminated encephalitis.) - furosemide (hydrocephalus and increase intracranial pressure (ICP)) - lorazepam (to treat seizures associated with encephalitis)

What are the risk factors for recurrent febrile seizure

- family history of febrile seizures - age less than 18 months - Brief duration <1hr between onset of fever and seizure

Clinical features of febrile seizure?

- fever (>38C) - children between 6 months to 5 years - develop in first 24 hours of illness - Absence of CNS infection

what is the aetiology of encephalitis?

- human herpes simplex virus - influenza A - MMR - retrovirus

What is encephalitis?

- inflammatory process of the brain parenchyma leading to cerebral dysfunction. - caused by 2 mechanisms: - direct infection - apparent immune-mediated response

what is he pathophysiology of febrile seizure?

- occur on young children where their seizure threshold is low. - susceptible to frequent childhood infections such as upper respiratory infection, otitis media, viral syndrome - Endogenous pyrogens, such as interleukin 1beta, that, by increasing neuronal excitability, may link fever and seizure activity - Cytokine network is activated and may have a role in the pathogenesis of febrile seizures

what is the complication of BM

- subdural effusion - cerebral edema - prolonged fever