Seizures

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Seizures
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Case 1

• A four years old boy was brought with generalized
  tonic - clonic convulsion with history of fever
• Attention to maintenance of airway, breathing and
  circulation
• Convulsion controlled
• No significant family history
• Developmental History normal

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Case 1 contd

• After control of seizures
• Pulse, BP Normal
• CNS Patient comatose
• No obvious cranial nerve palsy
• No papilledema
• No focal deficit
• No signs of meningeal irritation
• P/A Liver 3 cm soft Spleen 2 cm soft
• No other clinical abnormality

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CNS Normal
CNS Abnormal
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Investigations

• Hb 8 gm, WBC 15400 / mm3
• P. falciparum on peripheral smear
• CT Scan showed Cerebral edema
• Diagnosis
• Cerebral Malaria

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CNS Abnormal
CNS Normal
Intra cranial infection Complex Febrile Seizures
Simple Febrile Seizures
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Case 2

• An eleven years old boy with
• Twitching of left side of the body without
  alteration of sensorium multiple episodes
  lasting for 2-3 min over last 2 days
• No history of fever
• No H/O headache / Decd. school performance
• Birth and developmental history Normal

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Physical examination

• Vital parameters Stable
• CNS examination
• Conscious and well-oriented
• Higher functions Normal
• Fundus Examination No papilledema
• No focal deficit
• Other systems Normal

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CNS Abnormal
CNS Normal
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Investigations

• CT Scan
• Multiple sub-centimeter ring enhancing lesions
  with surrounding edema. An eccentric point is
  also noted suggestive of a scolex
• Diagnosis
• Neurocysticercosis

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Hypocalcemia Tuberculoma Neurocysticercosis Epilep
sy
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Case 3

• An eleven months old girl
• Generalized tonic clonic convulsions, two
  episodes each lasting for 5 min each in the last
  24 hours
• Prior to that the child had cough and mild fever
  two days prior to convulsions
• No significant family history
• Product of non-consanguineous union
• No significant perinatal history
• Mild developmental delay

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Physical Examination

• Vital parameters Normal
• CNS examination
• Hypotonia
• Developmental age 6 mo
• Other systems No abnormality detected

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Brain damage HIE Epilepsy
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Investigations

• MRI Cortical atrophy
• Metabolic investigations proved the diagnosis of
  Glutaric aciduria type 2

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Case 4

• An eight months old boy was brought with
  complaints of generalized tonic clonic
  convulsions lasting for 5 minutes
• The child had high fever at the time of
  convulsions
• Development history was normal
• Father had taken anti-convulsants during
  childhood for 4 years for afebrile seizures
• Patients drowsiness subsided within 5 minutes
  of convulsion control

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Physical Examination

• Conscious
• No Cranial Nerve Deficits
• Tone, power Normal
• No signs of meningeal irritation
• Developmental assessment Normal

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CNS Abnormal
CNS Normal
Intra cranial infection Complex Febrile Seizures
Simple Febrile Seizures
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Red Flags

• All seizures A medical emergency
• History of head trauma
• Status epilepticus
• Seizures that are difficult to control
• Manifestations of raised intra-cranial pressure
• Appearance of new neurological abnormalities
• Neonatal seizures

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Other Factors

• Age
• Birth history
• Consanguinity
• Family history
• Unexplained sib deaths
• Symptoms suggestive of raised ICP
• Symptoms suggestive of cranial nerve and motor
  deficits
• History of loss of milestones
• Developmental history
• Seizure focal or generalized
• Poisoning
• Drug Compliance in a patient on treatment

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Other Factors

• Blood pressure
• Focal neurological deficits
• Meningeal signs
• Microcephaly
• Fundus examination
• Neuro-cutaneous markers of phakomatoses

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CNS Abnormal
CNS Normal
Intra cranial infection Complex Febrile Seizures
Simple Febrile Seizures
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Hypocalcemia Tuberculoma Neurocysticercosis Epilep
sy
Brain damage HIE Epilepsy