Thursday, August 17, 2006

Interesting Case

Here's an interesting, quick-hitter of a case to review from another doc...

  • 3 yo male presents s/p first-ever sz
  • Generalized tonic-clonic sz for 5 minutes
  • No fever prior or after
  • No significant PMHx
  • No trauma or meds (was at daycare) and it was witnessed.
  • PE: AF, VSS
  • Pertinent findings:
  • Pt w/ his gaze towards the right without regard for anything in his left visual field
  • LUE/LLE paralysis
  • + Babinski on left
  • Pt fussy and crying
  • All other findings unremarkable

DDx:

  • Obviously mass or space occupying brain lesion would be a consideration
  • Meningitis/encephalitis possible (not febrile and not acting ill before hand but you have to consider it)
  • SAH
  • It should not be a vertebrobasilar dissection based on neuroanatomy

Trx:

  • Pt was maintaining his airway and RSI held
  • The doc appropriately (in my mind) gave an initial dose of decadron (for either encephalitis, meningitis or neuroedema)
  • Stat CT head
  • Labs (usual)
  • LP

Results:

  • CT head negative
  • Labs unremarkable
  • LP: 100 RBC, 5 WBC

Course:

  • Pt's course showed gradual improvement (not completely) of paralysis and neuro deficits
  • Pt was transferred to PCH (just done yesterday so final dx pending)
  • My thoughts on this case is that the doc did everything appropriately. I bet the final diagnosis is...

Todd Paralysis

  • S/p seizure activity
  • It consists of focal or unilateral paralysis or neuro deficit after seizure activity, lasting up to 48 hours.
  • There is no specific treatment for it (just to r/o other specific causes)
  • Sx's resolve on their own (as it appeared to be in this child)

2 Comments:

Blogger PMac said...

I would have sent the kid home with that diagnosis...transfer...weak..smirk

6:58 PM  
Blogger Erik Mattison, M.D. said...

I personally harassed the treating doc (rhymes with mattison) that it was a weak admit.

4:57 PM  

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