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)