A 24 month old boy was seen in the emergency room following a seizure accompanied by fever, his fourth in 6 months. The child had been well until the previous day, when a temperature of 38.9 developed and the pediatrician prescribed amoxicillin after discovering left otitis media on exam.
The following morning, temperature spiked to 39.4 and the boy experienced a 2 minute generalized tonic-clonic seizure just as father was administering acetaminophen. Afterwards, the child was somnolent for several minutes, but quickly resumed normal alertness.
Prior seizures had occurred at the ages of 18, 20, and 23 months with fever exceeding 39.0 in each instance. Prior seizures were otherwise identical in duration and character.
Past medical history was noncontributory. Development was normal, with independent walking at 12 months and present use of single sentences. Review of family history revealed that an older sister had suffered from similar seizures during fever until age 3.
In the emergency room, the boy was alert and appeared only minimally ill. Temperature was 38.4. General physical exam revealed a dull and erythematous left tympanic membrane and mild cervical adenopathy. No nuchal rigidity or other meningeal signs were apparent.
Neurologic examination was entirely nonfocal and the child's motor skills, language, and social interaction seemed normal for age.
MRI of the brain and EEG had both been previously performed
and were normal. No additional studies were deemed necessary at the time
of the ER visit.
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Created: July 25, 1995