January Week 1: Febrile Seizures
A 5 month old female is brought to the ER after mom called 911 because
the baby started to “shake” his arms and legs at home approximately 25
minutes ago. The episode last for about a minute or two, says the
mom. She was vigorously shaking both upper and lower extremities and
did not lose consciousness or turn blue. She has seemed “lethargic”
since it ended. The child is currently lying in the mom’s arms. Mom
thinks it was a “seizure”.
Per the mother’s history, the patient has been sick with “cough,
congestion, runny nose” for the past 3 or 4 days. She has been
running fevers > 103 since yesterday. Mom has been treating with
tylenol alternating with motrin and the fevers recur.
On exam, the infant’s vital signs are as follows: T 39.2, HR 115, RR
40, BP 85/45.
She seems sleepy in her mother’s arms. Nares are congested; TMs
normal. Throat appears erythematous. Heart exam is normal. Lungs
are clear, with transmitted upper airway sounds. Abdomen is normal.
Reflexes are normal.
Please consider the following in your discussion:
1) What is in your differential for the cause of this fever? And
stemming from this, should this child undergo an LP?
2) Does this child need any imaging? MRI or CT?
3) Can this child be discharged from the ER? What is her most likely
disposition given the above scenario?
4) Mom asks if she is at risk for “epilepsy”? What (if any) are the
long-term implications of this seizure? Can this seizure be