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Seizures in a Four-month old Male

Seizures in a Four-month old Male. Grullo , Precious Hipolito , Cecilia Illescas , Neil Jara , Mikaela Nikkola. L.B. 4 months old male Biñan , Laguna Admitted on 2/7/10 CC: seizures. History of Present Illness.

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Seizures in a Four-month old Male

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  1. Seizures in a Four-month old Male Grullo, Precious Hipolito, Cecilia Illescas, Neil Jara, MikaelaNikkola

  2. L.B. • 4 months old male • Biñan, Laguna • Admitted on 2/7/10 • CC: seizures

  3. History of Present Illness • Four weeks prior to admission, patient had on-and-off hacking non-productive cough and episodes of vomiting with passage of whitish mucoid material. No fever or difficulty of breathing noted. No consults done and no medications.

  4. History of Present Illness • One week prior to admission, there was on-and-off nonproductive cough with associated fever (Tmax 38 deg Celsius). Good suck and good cry. Brought to a District Hospital. Started on Cefaclor TID with good compliance.

  5. History of Present Illness • Three days prior to admission, persistence of signs and symptoms, (+) increased sleeping time. Brought to a local hospital where patient was admitted. Started on IV ampicillin. Decreased irritability. Decreased sleeping time.

  6. History of Present Illness • One day prior to admission, (+) cough, fever (Tmax of 39.4 deg Celsius). (+) seizures: upward rolling of eyeballs, circumoral cyanosis, tonic-clonic movement of all extremities (+) gagging during the seizure episode and brought to the ER of the same hospital Advised transfer to a tertiary hospital.

  7. Review of Systems (-) weight loss (-) DOB (-) abdominal pain (-) vomiting (-) diarrhea (-) urinary changes (+) good activity (+) good cry

  8. Birth and Maternal History • Full term • 19 year old G1PO • Home delivery assisted by a midwife • Irregular PNCUs c/o LHC • (+) maternal illness: UTI at 7 months AOG, treatment with Amoxicillin TID x 7 days • (-) teratogens / radiation / chemical exposure

  9. Birth and Maternal History • At birth, (+) aspiration/copious secretions  brought to a local hospital for suctioning, discharged apparently well

  10. Past Medical History (+) hospitalization for CAP at 2 weeks of age Salbutamolnebulization and antibiotics medications. (-) known allergies

  11. Family Medical History • (+) Hypertension – maternal grandmother • (-) DM / PTB / BA / CA

  12. Nutritional History • Exclusively breastfed since birth

  13. Immunization History • (+) BCG • (+) OPV 1 • (+) DPT 1 • (+) Hep B 1 C/o LHC

  14. Developmental History • Can turn from side to side • Head control at two months of age

  15. Personal Social History • Mother is a 19 year old fishball vendor. • Father is 30 years old with irregular job status. • First child.

  16. Physical Examination: On Admission • Awake, active, not in cardiorespiratory distress • BP 80/50 HR 130s RR 48 T 38 • Weight 6 kg HC 39 cm • Anictericsclerae, pink palpebral conjunctivae, (+) alar flaring, (-) tonsillopharyngeal congestion, (-) CLAD • Equal chest expansions, (-) retractions, (+) coarse crackles, bilateral, (-) wheezes, (+) rhonchi, bilateral

  17. Physical Examination: On Admission • Adynamicprecordium, distinct heart sounds, normal rate regular rhythm, (-) murmurs • Globular, soft, normoactive bowel sounds, (-) tenderness/masses • Full and equal pulses, pink nail beds, (-) cyanosis/edema/clubbing

  18. Physical Examination: On Admission • Neurological Examination: Awake, active Pupils 2 mm EBRTL, EOMs full, corneals intact, (-) facial asymmetry, good gag, tongue midline Motor: 5/5 on all extremities Sensory: withdraws to pain on all extremities DTRs: ++ on all, (-) clonus/Babinski/nystagmus/nuchal rigidity

  19. Assessment Community-acquired pneumonia Acute symptomatic seizure probably secondary to: 1. CNS infection 2. Metabolic R/O benign febrile seizure R/O sepsis

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