12. PERSONAL H/O
age
*infantile spasm 3m-8m,rare after 2 years,
*absence seizures 5-10 years ,rare before 2 years,
*febrile convulsions 6m-6years.
sex
)absence seizures more in girls(.
Address to know the distance.
HISTORY
14. H/O present illness Ictal , Preictal , Postictal.
Analysis of abnormal movement
Describe this movement,
How does it begin,
Is it focal or generalized,
How much it last,
Is it the first time or not,
Is it associated with:
loss of consciousness ,up rolling of eye ,cyanosis,
secretions from mouth, head tilting, twitching of face ,
arching of spine, tongue bite, passage of urine or stool
during the attack.
15. the pre-attack state of child ,is it perceded by:
fever & how much it was if measured by mother
)thinkof CNS infection orfebrile convulsion “if within
suggested age”(
Physical or emotional stress like excessive crying BHA
orangerSA.
Loud noisy sounds or strong flashes of light
Sleepy or just awake from sleep
possible Drugs (TCA, sympathomimitics, amphetamine(
or toxin ingestion.
Recent vaccinations
Trauma : describe trauma & assess its severity
16. thepost-attack stateof thechild
1-Was the attack followed by:
-Deep sleep
-Coma
-Weakness or paralysis of limbs
&how much each of those persist
2-how was the attack finished:
spontaneously or with medications?
17. Systemic review
In systemic review try to roll out:
*-Infection of CNS or any other system
*-hi ICP :vomiting, (headache & blurred vision in
older children(.
*-Dehydration & electrolyte imbalance:
Suggested by h/o severe diarrhea or vomitting.
18. Birth H/O “Must be taken in detail”
ANH: chronic illness (DM , HTN, PE ( , any bleeding:
suggest Ischemic-hypoxic ecephalopathy.
Exposure to radiation or ingestion of teratogenic drugs
( as a cause of congenital cerebral malformations(
Natal H/O : prolonged or precipitate labour ,abnormal
presentation, cord around the neck; (as cause of
birth asphyxia(.
Maturity (premature more risk of IVH , post mature
risk of MAS(.
19. Post natal H/O
-Birth weight (LBW IVH( , cried immediately or not.
-Discharged on the same day or stayed in NN ICU.
-Any postnatal admission , h/o jaundice ( assess
whether it was significant or not , e.g. when
appeared, disappeared, how treated?...(
20. Immunization h/o : if the attack preceded by
vaccination.
Developmental h/o:
How old is child now & what can he do?
Was the child well & then regress in development
(think of neurodegenerative disorders(
Presence of any neurological abnormality exclude
febrile convulsions.
21. Past H/O:
*Ask whether this is the first attack or not, if not:
Describe the previous attacks , how treated ,and
what was the diagnosis?
*Any previous admissions to hospital
*Any significant illness:
-Cerebral palsy: risky to develop seizures
-Renal failure: presented with seizures due to
hypocalcaemia, hyponatremia
-DM : complicated by hypoglycemia
22. Family H/O
1-Of similar attacks, what was diagnosis (febrile
convulsion usually have positive family
H/O(
2-Of epilepsy
3-of consanguinity ( may suggest inherited
metabolic disorders(
23. 1-General examination
*Level of consciousness (GCS(
*Vital signs & search for any obvious focus of infection.
*Bulged AF in infant , papilledema in older children may
suggest ICP.
*In older children ,check signs of meningeal irritation.
*Examine skin for stigmata of neuro-cutaneous
disorders( café aulait spots, hypopigmented areas
,hemangioma(
2-Complete neurological examination to make
sure of normal CNS.
3-Developmental assessment
EXAMIANTION
24. *CBC
*Blood glucose
*Septic work-up:
(Blood culture,urine culture, LP, CXR, throat swab(.
*Serum electrolytes( Na ,Mg ,Ca(
*Toxicology screen ( if drug overdose suspected( or
metabolic screen
*CT,MRI : if ho trauma or suspect rise ICP.
*EEG may play a role.
INVESTIGATION
25. Initial treatment:
A-Maintain airway patent , Put child in semi
-prone position with head down to help
drainage of secretions.
B-Adequate breathing : O2 mask
C-Circulation : iv drip , normal saline & dextrose
D-Drugs : diazepam ,phenytoin ,phenobarbitone
Treatment of the cause accordingly.
Treatment
26.
27. طاهر فخري فاطمة11 months old,
female Libyan patient, lives in Benghazi
((الليثي , blood group is A+ve , and the
history is taken from her mother.
She’s admitted on Friday 23th of may
2008 , at 5 pm,
Complaining of high fever and abnormal
movement for 2 days before the
admission.
28. Fever was high grade, measuring up to 40°C ,
starting from 2 weeks back as a symptom of
gastroenteritis.
She had supportive and symptomatic treatment, but
fever didn’t relieve completely.
Not associated with sweating , skin rash, chills or
rigors.
No h/o any ill person of the family.
Panadol and cold sponging was used to decrease the
temperature. With no increasing factors.
29. Regarding the abnormal movement:
The 1st
attack was on Friday before dawn at
2:30 am. Which persist for 15 minutes.
The mouth was cyanosed, and jerky movement
of upper and lower limbs with loss of
consciousness.
Post ictally, Fatima was sleepy and fatigue.
32. Blood glucose 77
Blood urea 17
S. creatinine 0.5
Na 135
Ca 1.14
33. Lumber puncture: ( normal result )
CSF glucose 67 mg
CSF protein 19 mg
No RBCs or WBCs.
34. X-ray hand is done.
And Fatima was putted on convulsion chart.
35. Next 2 days :
No other attacks had been happened.
Mother is advised to notice any rising in
temperature of her daughter.
And discharged!!!!!.
36.
37. مسعود أشرف أحمد4 years old Libyan patient,
lives in Benghazi. History is taken from his
mother.
Admitted to the hospital on Thursday,
12nd of June 2008 because of an
abnormal limb movements 2 days before
the admission.
38. No thing abnormal on examination,
Also no thing abnormal by investigation .
