Model Answer
0 min readIntroduction
Febrile seizures are the most common type of seizure in children, occurring in 2-5% of children between 6 months and 5 years of age. They are typically associated with a rapid rise in body temperature, often due to an underlying infection. While generally benign, febrile seizures can be frightening for parents and require prompt medical evaluation to rule out serious underlying conditions like meningitis or encephalitis. This answer will discuss the diagnosis and management of a one-year-old boy presenting with high-grade fever and convulsions of one-day duration, adhering to standard pediatric protocols.
I. Initial Assessment & Stabilization
The immediate priority is to stabilize the child and ensure airway, breathing, and circulation (ABC). This includes:
- Airway: Ensure a patent airway.
- Breathing: Assess respiratory rate and effort. Provide supplemental oxygen if needed.
- Circulation: Check heart rate and blood pressure. Establish intravenous (IV) access.
- Seizure Control: If the seizure is ongoing, administer benzodiazepines (e.g., Diazepam 0.2-0.5 mg/kg IV/rectal) to terminate it. Lorazepam (0.1mg/kg IV) is often preferred due to longer duration of action.
- Monitoring: Continuous monitoring of vital signs (heart rate, respiratory rate, blood pressure, temperature, oxygen saturation) and neurological status.
II. History Taking
A detailed history is crucial to identify the cause and risk factors. Key areas to cover include:
- Presenting Complaint: Duration of fever, characteristics of convulsions (focal vs. generalized, duration, postictal state).
- Past Medical History: Previous seizures, developmental milestones, underlying medical conditions.
- Family History: Family history of epilepsy or febrile seizures.
- Immunization Status: Up-to-date vaccination status, particularly against Haemophilus influenzae type b (Hib) and pneumococcus.
- Recent Illnesses: Exposure to sick contacts, recent travel, any signs of infection (e.g., cough, runny nose, diarrhea).
III. Physical & Neurological Examination
A thorough physical and neurological examination is essential:
- General Examination: Assess hydration status, signs of infection (e.g., rash, meningeal signs).
- Neurological Examination: Assess level of consciousness, pupillary response, cranial nerve function, motor strength, reflexes, and presence of any focal neurological deficits. Look for signs of meningeal irritation (Kernig’s and Brudzinski’s signs).
IV. Differential Diagnosis
Several conditions can present with fever and convulsions in a one-year-old. The differential diagnosis includes:
- Simple Febrile Seizure: Most common. Generalized tonic-clonic seizure associated with fever, without evidence of central nervous system (CNS) infection.
- Complex Febrile Seizure: Prolonged (>15 minutes), focal, or recurrent within 24 hours.
- Meningitis: Inflammation of the meninges, often bacterial.
- Encephalitis: Inflammation of the brain parenchyma, often viral.
- Status Epilepticus: Prolonged seizure activity or repeated seizures without full recovery of consciousness between them.
- Electrolyte Imbalance: Hyponatremia, hypocalcemia.
- Intracranial Mass: Rare, but should be considered if focal neurological deficits are present.
V. Investigations
Investigations are guided by the clinical presentation and suspicion of underlying cause:
- Complete Blood Count (CBC): To assess for infection.
- Blood Culture: To identify bacterial pathogens.
- Urine Analysis & Culture: To rule out urinary tract infection (UTI).
- Lumbar Puncture (LP): Crucial to rule out meningitis or encephalitis, especially if there are meningeal signs, altered mental status, or focal neurological deficits. CSF analysis includes cell count, protein, glucose, Gram stain, and culture.
- Electrolytes, Glucose, Calcium: To rule out metabolic causes.
- Neuroimaging (CT/MRI): Considered if there are focal neurological deficits, prolonged seizures, or suspicion of intracranial pathology.
- Viral PCR: For common viral pathogens (e.g., enterovirus, herpes simplex virus) if encephalitis is suspected.
VI. Management
Management depends on the diagnosis:
- Simple Febrile Seizure: Supportive care, antipyretics (e.g., paracetamol, ibuprofen) to reduce fever. Observation in the hospital until seizure-free and afebrile. Parental education regarding febrile seizure management.
- Complex Febrile Seizure: Hospital admission, continuous EEG monitoring, and investigation for underlying cause.
- Meningitis/Encephalitis: Prompt initiation of appropriate antibiotics/antivirals based on CSF findings. Supportive care, including fluid management and seizure control.
- Status Epilepticus: Second-line anticonvulsants (e.g., Phenobarbital, Phenytoin, Levetiracetam) if benzodiazepines are ineffective. Consider ICU admission.
Conclusion
Managing a one-year-old with fever and convulsions requires a systematic approach, prioritizing stabilization, accurate diagnosis, and appropriate treatment. While simple febrile seizures are common and generally benign, it is crucial to rule out serious underlying conditions like meningitis or encephalitis through thorough investigation. Parental education and reassurance are vital components of care. Long-term follow-up may be necessary, particularly for children with complex febrile seizures or underlying neurological conditions.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.