Content area
Full Text
Convulsive status epilepticus is a common paediatric emergency with an incidence of 20/100000 per year. 1 However, it is important to review the diagnosis in the light of a history of responsiveness out of keeping with generalised limb and eye jerking, or if treatment does not prove effective. We present two cases of a florid movement disorder presenting as convulsive statues epilepticus. Video footage of both patients at the time of diagnosis is available online.
Patient A
This 4-month-old, previously well, boy presented to his general practitioner (GP) with a 3-day history of being unwell with vomiting and "violent shaking". The GP noted that the boy's eyes were "rolling and shaking" and he thought the child might be intermittently fitting. A rash was noted on the abdomen and legs. The boy was sent immediately to the emergency department for assessment. The patient's clinical details are summarised in table 1 .
Patient A | Patient B | |
Age at presentation | 4 months | 15 months |
Gender | Male | Male |
Ethnicity | British Caucasian | Pakistani |
Duration of symptoms prior to presentation | 3 days | 1 day |
Symptoms and signs | Vomiting | Low-grade fever |
Violent shaking of the limbs - not suppressed by holding the limb | Intermittent jerking of limbs - appeared to grab onto his mother's arm | |
Eyes rapidly moving unpredictably in all directions | Rapid progression to more violent limb shaking | |
Pupils reactive to light (with increased abnormal eye movements when stimulated) | Rapid multidirectional unpredictable eye movements | |
Non-blanching rash | Very distressed, crying out, but responsive to mother's voice | |
Low-grade fever | ||
Sinus tachycardia in keeping with agitation | ||
Normal perfusion | ||
Very distressed but responsive to mother's voice | ||
Initial diagnosis | Meningococcal septicaemia with CNS involvement causing convulsive status epilepticus | Encephalitis with convulsive status epilepticus |
Initial treatment | IV antibiotics | IV antibiotics and acyclovir |
2 doses IV lorazepam | 2 doses IV lorazepam | |
IV phenytoin loading | Rectal paraldehyde | |
Anaesthesia with intubation and ventilation on PICU | IV phenytoin loading | |
Anaesthesia intubation and ventilation on PICU |
CNS, central nervous system; IV, intravenous; PICU, paediatric intensive care unit.
In hospital, the infant was noted to be irritable and jittery, but responsive, with...