A 2-year-old girl - okt3

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is brought the emergency department by her parents because of a high fever and generalized "body convulsions." The parents say that she was "pretty fussy" all day and her temperature at that time was 37.3 C (99.2 F). Over the past few hours, she began to "burn up," with her temperature spiking to 39.7 C (103.4 F). They put her into her crib to go to sleep, and they heard "banging" coming from the baby monitor in their bedroom. When they arrived in her room 10 seconds later, her entire body was "shaking". It lasted about 2 minutes, which seemed like a "lifetime" to them, and did not recur. She was lethargic and drowsy for 5 minutes after the "shaking". Nobody in the family has ever had a seizure before. Her temperature is 39.3 C (102.8F). Neurologic examination is unremarkable. A chest x-ray shows a left lower lobe consolidation. A lumbar puncture shows:

The parents are concerned about the severity of their daughter's condition and what they can expect in the future.
The most appropriate response is

A. "Luckily, you got to the hospital in time to avoid complications such as hydrocephalus, hearing loss, speech or developmental delays, and mental retardation."
B. "Since you do not have a family history of febrile seizures, chances are that she will go on to have idiopathic epilepsy."
C. "This episode is due to her pulmonary infection, and it will never recur."
D. "Your daughter will most likely have a complete recovery and there is only a very small chance that she will develop epilepsy."
E. "Your daughter's condition is very serious and a full evaluation for epilepsy is indicated at this time."

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lumbar puncture shows:
Color: clear
glucose:55mg/dL
protein:22 mg/dl
lymphocytes: 4/mm3

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dd,

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D,

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yes D

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A 2-year-old girl is brought the emergency department by her parents because of a high fever and generalized "body convulsions." The parents say that she was "pretty fussy" all day and her temperature at that time was 37.3 C (99.2 F). Over the past few hours, she began to "burn up," with her temperature spiking to 39.7 C (103.4 F). They put her into her crib to go to sleep, and they heard "banging" coming from the baby monitor in their bedroom. When they arrived in her room 10 seconds later, her entire body was "shaking". It lasted about 2 minutes, which seemed like a "lifetime" to them, and did not recur. She was lethargic and drowsy for 5 minutes after the "shaking". Nobody in the family has ever had a seizure before. Her temperature is 39.3 C (102.8F). Neurologic examination is unremarkable. A chest x-ray shows a left lower lobe consolidation. A lumbar puncture shows:

The parents are concerned about the severity of their daughter's condition and what they can expect in the future. The most appropriate response is
A. "Luckily, you got to the hospital in time to avoid complications such as hydrocephalus, hearing loss, speech or developmental delays, and mental retardation."
B. "Since you do not have a family history of febrile seizures, chances are that she will go on to have idiopathic epilepsy."
C. "This episode is due to her pulmonary infection, and it will never recur."
D. "Your daughter will most likely have a complete recovery and there is only a very small chance that she will develop epilepsy."
E. "Your daughter's condition is very serious and a full evaluation for epilepsy is indicated at this time."
Explanation: The correct answer is D. This patient most likely had a febrile seizure, which is a seizure associated with fever without acute intracranial infection or electrolyte imbalance. The peak occurrence is between 6 months and 5 years. These episodes last less than 15 minutes and typically follow a rapid rise in temperature. The main priority is to diagnose the source of infection. This patient seems to have pneumonia that is causing a high fever. There is a 30-50% chance that she will have another febrile seizure. Patients with a generalized tonic-clonic febrile seizure who have a normal neurologic examination and lack a family history of epilepsy, only have a very small chance (2-3%) of progressing to epilepsy.It is inappropriate to say, "Luckily, you got to the hospital in time to avoid complications such as hydrocephalus, hearing loss, speech or developmental delays, and mental retardation" (choice A). These complications are possible after meningitis, and this patient had a febrile seizure, has normal cerebrospinal fluid, and pneumonia, which makes the diagnosis of meningitis unlikely. Also, even if she did have meningitis, it is inappropriate to tell the parents that they avoided these complications because there is no real way to determine that at this time.It is inappropriate to say, "Since you do not have a family history of febrile seizures, chances are that she will go on to have idiopathic epilepsy" (choice B). The parents said that nobody in the family has ever had a seizure, which most likely means a febrile seizure or epilepsy. A lack of family history of febrile seizures (or epilepsy) does not increase a patient's risk of developing epilepsy. If there was a family history of seizures, especially epilepsy, she would be at an increased risk of developing epilepsy."This episode is due to her pulmonary infection, and it will never recur" (choice C) is incorrect because while this febrile seizure was most likely due to the fever associated with her pulmonary infection, you cannot say that it will "never" recur. Febrile seizures recur in 30-50% of children, but only rarely progress to epilepsy."Your daughter's condition is very serious and a full evaluation for epilepsy is indicated at this time" (choice E) is incorrect because she most likely had a febrile seizure, due to the rapid rise in temperature associated with a pulmonary infection. Her lumbar puncture was completely normal. A full evaluation for epilepsy is generally not indicated in the case of a simple febrile seizure.

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d........................